Low-level laser therapy (LLLT) is a form of light therapy that triggers biochemical changes within cells. Photons are absorbed by cellular photoreceptors, triggering chemical alterations and ...potential biochemical benefits to the human body. LLLT has been used in pain management for years and is also known as cold laser therapy, which uses low-frequency continuous laser of typically 600 to 1000 nm wavelength for pain reduction and healing stimulation. Many studies have demonstrated analgesic and anti-inflammatory effects provided by photobiomodulation in both experimental and clinical trials.
The purpose of this research article was to present a summary of the possible pain management benefits of LLLT.
In cold laser therapy, coherent light of wavelength 600 to 1000 nm is applied to an area of concern with hope for photo-stimulating the tissues in a way that promotes and accelerates healing. This is evidenced by the similarity in absorption spectra between oxidized cytochrome c oxidase and action spectra from biological responses to light. LLLT, using the properties of coherent light, has been seen to produce pain relief and fibroblastic regeneration in clinical trials and laboratory experiments. LLLT has also been seen to significantly reduce pain in the acute setting; it is proposed that LLLT is able to reduce pain by lowering the level of biochemical markers and oxidative stress, and the formation of edema and hemorrhage. Many studies have demonstrated analgesic and anti-inflammatory effects provided by photobiomodulation in both experimental and clinical trials.
Based on current research, the utilization of LLLT for pain management and osteoarthritic conditions may be a complementary strategy used in clinical practice to provide symptom management for patients suffering from osteoarthritis and chronic pain.
Objective: Effusion-synovitis is related to pain and progression in knee osteoarthritis (OA), but current gold standard ultrasound (US) measures are limited to semi-quantitative grading of joint ...distension or 1-dimensional thickness measures. A novel quantitative 2-dimensional image analysis methodology is applied to US images of effusion-synovitis; reliability and concurrent validity was assessed in patients with knee OA. Methods: Cross sectional analysis of US images collected from 51 patients with symptomatic knee OA were processed in ImageJ and segmented in 3DSlicer to produce a binary mask of the supra-patellar synovitis region of interest (ROI). Area measures (mm2) of total synovitis, effusion and hypertrophy components were exported. Intra-rater reliability and test-retest reliability (1–14 days washout) were estimated with intra-class correlation coefficients (ICCs). Concurrent validity was measured by Spearman correlations between quantitative measures and gold standard OMERACT and caliper measurements of synovitis. Results: Intra-rater reliability for hypertrophy area was estimated at 0.98, 0.99 for effusion area, and 0.99 for total synovitis area. The test-retest reliability for total synovitis area was 0.63 (SEM 87.8 mm2), 0.59 for hypertrophy area (SEM 21.0 mm2), and 0.64 for effusion area (SEM 73.8 mm2). Correlation between total synovitis area and OMERACT grade was 0.84, 0.81 between total synovitis area and effusion-synovitis calipers, and 0.81 between total effusion area and effusion calipers. Conclusion: This new research tool for image analysis demonstrated excellent intra-rater reliability, good concurrent validity, and moderate test-retest reliability. Quantitative 2D US measures of effusion-synovitis and its individual components may enhance the study and management of knee OA.
Objective:
Sonographic evaluation for acute appendicitis in children often involves an exhaustive protocol, for which the therapeutic yield has not been formally evaluated. The purpose of the study ...was to pilot a retrospective chart review of children receiving an abdominopelvic sonogram upon presenting with suspected acute appendicitis.
Methods:
An annual retrospective chart review was designed to review abdominopelvic sonograms to rule out appendicitis and specifically performed at a Canadian children’s teaching hospital. Studies were excluded if the requisition stated multiple clinical concerns or if the patient was >18 years at the time of the sonogram.
Results:
Based on 230 patient cases reviewed, alternative diagnostic sonographic findings were found in 141 (61%) charts. Only 18 patient cases (8%) demonstrated both alternative sonographic findings as well as a change in management by the emergency room physician.
Conclusion:
Alternative diagnostic findings, based on a complete abdominopelvic sonogram, were common (61%) in this chart review but rarely changed patient management.
Effusion-synovitis is related to pain and progression in knee osteoarthritis (OA), but current gold standard ultrasound (US) measures are limited to semi-quantitative grading of joint distension or ...1-dimensional thickness measures. A novel quantitative 2-dimensional image analysis methodology is applied to US images of effusion-synovitis; reliability and concurrent validity was assessed in patients with knee OA.
Cross sectional analysis of US images collected from 51 patients with symptomatic knee OA were processed in ImageJ and segmented in 3DSlicer to produce a binary mask of the supra-patellar synovitis region of interest (ROI). Area measures (mm2) of total synovitis, effusion and hypertrophy components were exported. Intra-rater reliability and test-retest reliability (1–14 days washout) were estimated with intra-class correlation coefficients (ICCs). Concurrent validity was measured by Spearman correlations between quantitative measures and gold standard OMERACT and caliper measurements of synovitis.
Intra-rater reliability for hypertrophy area was estimated at 0.98, 0.99 for effusion area, and 0.99 for total synovitis area. The test-retest reliability for total synovitis area was 0.63 (SEM 87.8 mm2), 0.59 for hypertrophy area (SEM 21.0 mm2), and 0.64 for effusion area (SEM 73.8 mm2). Correlation between total synovitis area and OMERACT grade was 0.84, 0.81 between total synovitis area and effusion-synovitis calipers, and 0.81 between total effusion area and effusion calipers.
This new research tool for image analysis demonstrated excellent intra-rater reliability, good concurrent validity, and moderate test-retest reliability. Quantitative 2D US measures of effusion-synovitis and its individual components may enhance the study and management of knee OA.
The purpose of this research was to employ the audit method to measure performance and identify targets of change, setting a template for future large-scale investigations that may inform decisions ...involving sonographer role expansion in Canada. The authors conducted an audit of 433 sonographic examinations performed in the ultrasound department of a Canadian hospital. Sonographer reports were contrasted with radiologist final reports, and a degree of agreement (DoA) 1 to 4 was assigned to each exam package. In total, 322 of 429 (75%) exam packages were ranked as DoA 1 (complete agreement between sonographer and radiologist), 86 of 429 (20%) were ranked as DoA 2, 16 of 429 (4%) were ranked as DoA 3, and 5 of 429 (1%) were ranked as DoA 4 (significant discrepancy between sonographer and radiologist). The results revealed a 75% agreement between sonographer and radiologist on imaging findings as they are recorded in technical impression sheets and reports. Discrepancies are usually minor and involve the omission of incidental findings by the radiologist.
The objective of this study was to develop a deep-learning-based approach to automatically segment 3D ultrasound images of the synovial tissue in osteoarthritis of the first carpometacarpal (CMC1 ...OA).
Deep learning predictions on 2D ultrasound slices sampled in the transverse plane were used to view the synovial tissue of the first carpometacarpal in patients with OA, followed by reconstruction into 3D surfaces. A modified 2D U-Net was trained using a dataset of 832 2D US images resliced from 89 3D US images. Segmentation accuracy was evaluated using a testing dataset of 208 2D US images resliced from 15 3D US images. Absolute and signed performance metrics were computed, and segmentation performance was compared between the manual segmentations of raters 1 and 2.
Results of the U-Net-based run were mean 3D DSC 86.9 ± 4.8%, recall 93.7 ± 3.6%, precision 81.1 ± 6.9%, volume percent difference 16.9 ± 10.2%, mean surface distance 0.18 ± 0.04 mm, and Hausdorff distance 1.8 ± 0.8 mm. The algorithm demonstrated an overall increase in performance after 3D segmentation reconstruction compared to 2D predictions, but the difference was not statistically significant.
This study investigated the use of a modified U-Net algorithm to automatically segment the synovial tissue volume (STV) of CMC1 OA patients and demonstrated that the addition of this deep learning method increases the efficiency of STV estimations in clinical trial settings.
Advancements in wireless ultrasound technology allow for point of care cartilage imaging, yet validation against traditional ultrasound units remains to be established for knee cartilage outcomes. ...Therefore, the purpose of our study was to establish the agreement of articular cartilage thickness and echo-intensity measures between traditional and wireless ultrasound units utilizing automatic-gain and normalization techniques. We used traditional and wireless ultrasound to assess the femoral cartilage via transverse suprapatellar scans with the knee in maximum flexion in 71 female NCAA Division I athletes (age: 20.0\(\pm\)1.3 years, height: 171.7\(\pm\)8.7 cm, mass: 69.4\(\pm\)11.0 kg). Wireless ultrasound images (auto-gain and standard gain) were compared to traditional ultrasound images (standard gain) before and after normalization. Ultrasound image pixel values were algebraically scaled to normalize imaging parameter differences between units. Mean thickness and echo-intensity of the global and sub-regions of interest were measured for unnormalized and normalized images. Intraclass correlation coefficients (\(ICC_{2,k}\)) for absolute agreement, standard error of the measurement, and minimum detectable difference were calculated between the traditional and wireless ultrasound units across both gain parameters and normalization. Cartilage thickness demonstrated good to excellent agreement for all regions (\(ICC_{2,k} = 0.83 {\text -} 0.95\)) regardless of gain and normalization. However, mean echo-intensity demonstrated poor to moderate agreement in all regions regardless of gain and normalization (\(ICC_{2,k} = 0.23 {\text -} 0.68 \)). While there was a high level of agreement between units when assessing cartilage thickness, further research in ultrasound beam forming may lead to improvements in agreement of cartilage echo-intensity between ultrasound units.
Multimorbidity is common among fracture patients. However, its association with osteoporosis investigation and treatment to prevent future fractures is unclear. This limited knowledge impedes optimal ...patient care. This study investigated the association between multimorbidity and osteoporosis investigation and treatment in persons at high risk following an osteoporotic fracture.
The Sax Institute's 45 and Up Study is a prospective population-based cohort of 267,153 people in New South Wales, Australia, recruited between 2005 and 2009. This analysis followed up participants until 2017 for a median of 6 years (IQR: 4 to 8). Questionnaire data were linked to hospital admissions (Admitted Patients Data Collection (APDC)), emergency presentations (Emergency Department Data Collection (EDDC)), Pharmaceutical Benefits Scheme (PBS), and Medicare Benefits Schedule (MBS). Data were linked by the Centre for Health Record Linkage and stored in a secured computing environment. Fractures were identified from APDC and EDDC, Charlson Comorbidity Index (CCI) from APDC, Dual-energy X-ray absorptiometry (DXA) investigation from MBS, and osteoporosis treatment from PBS. Out of 25,280 persons with index fracture, 10,540 were classified as high-risk based on 10-year Garvan Fracture Risk (age, sex, weight, prior fracture and falls) threshold ≥20%. The association of CCI with likelihood of investigation and treatment initiation was determined by logistic regression adjusted for education, socioeconomic and lifestyle factors). The high-risk females and males averaged 77 ± 10 and 86 ± 5 years, respectively; >40% had a CCI ≥2. Only 17% of females and 7% of males received a DXA referral, and 22% of females and 14% males received osteoporosis medication following fracture. A higher CCI was associated with a lower probability of being investigated adjusted OR, females: 0.73 (95% CI, 0.61 to 0.87) and 0.43 (95% CI, 0.30 to 0.62); males: 0.47 (95% CI, 0.33 to 0.68) and 0.52 (0.31 to 0.85) for CCI: 2 to 3, and ≥4 versus 0 to 1, respectively and of receiving osteoporosis medication adjusted OR, females: 0.85 (95% CI, 0.74 to 0.98) and 0.78 (95% CI, 0.61 to 0.99); males: 0.75 (95% CI, 0.59 to 0.94) and 0.37 (95% CI, 0.23 to 0.53) for CCI: 2 to 3, and ≥4 versus 0 to 1, respectively. The cohort is relatively healthy; therefore, the impact of multimorbidity on osteoporosis management may have been underestimated.
Multimorbidity contributed significantly to osteoporosis treatment gap. This suggests that fracture risk is either underestimated or underprioritized in the context of multimorbidity and highlights the need for extra vigilance and improved fracture care in this setting.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
