Retention, adherence, and acceptability testing of a digital health intervention in a 3-group randomized controlled trial for chronic musculoskeletal pain

OBJECTIVES

Evaluate a digital health intervention using Auricular Point Acupressure (APA) for chronic musculoskeletal pain in terms of participant retention, adherence, acceptability, and satisfaction. Chronic musculoskeletal pain is a global concern and there are persistent challenges in pain management. Despite the value of digital health interventions, these interventions need to be fully evaluated for feasibility.

METHODS

We conducted a 3-group, longitudinal, randomized controlled trial (RCT). After Institutional Review Board approval, we posted recruitment flyers in a university, healthcare clinics, and community settings. Participants were randomized into an in-person + app group (n = 8), virtual + app group (n = 7), and a wait-list, education-enhanced control group (n = 8), evaluating our outcomes using standard feasibility measures. The 4-week intervention consisted of virtual sessions, telecommunications, and our APA app, followed by a 3-month follow-up.

RESULTS

Data from 22 participants were subsequently analyzed (95.7%). All app participants adhered to the study protocol and used APA at the minimum recommended frequency and duration. The virtual + app group used APA more during the intervention and follow-up periods. All app participants found the intervention to be acceptable and at least 80% overall were satisfied with APA at the 3-month follow-up. There were no adverse events reported.

CONCLUSIONS

Our digital health intervention was found to be acceptable and sustainable; participants adhered to and were satisfied with the intervention providing support for a larger RCT.

CLINICAL TRIAL

#: NCT05020470.

Biological Correlates of the Effects of Auricular Point Acupressure on Pain

BACKGROUND

To identify candidate inflammatory biomarkers for the underlying mechanism of auricular point acupressure (APA) on pain relief and examine the correlations among pain intensity, interference, and inflammatory biomarkers.

DESIGN

This is a secondary data analysis.

METHODS

Data on inflammatory biomarkers collected via blood samples and patient self-reported pain intensity and interference from three pilot studies (chronic low back pain, n = 61; arthralgia related to aromatase inhibitors, n = 20; and chemotherapy-induced neuropathy, n = 15) were integrated and analyzed. This paper reports the results based on within-subject treatment effects (change in scores from pre- to post-APA intervention) for each study group (chronic low back pain, cancer pain), between-group differences (changes in scores from pre- to post-intervention between targeted-point APA [T-APA] and non-targeted-point APA [NT-APA]), and correlations among pain intensity, interference, and biomarkers.

RESULTS

Within-group analysis (the change score from pre- to post-APA) revealed statistically significant changes in three biomarkers: TNF-α (cancer pain in the APA group, p = .03), β-endorphin (back pain in the APA group, p = .04), and IL-2 (back pain in the NT-APA group, p = .002). Based on between-group analysis in patients with chronic low back pain (T-APA vs NT-APA), IL-4 had the largest effect size (0.35), followed by TNF-α (0.29). A strong positive monotonic relationship between IL-1β and IL-2 was detected.

CONCLUSIONS

The current findings further support the potential role of inflammatory biomarkers in the analgesic effects of APA. More work is needed to gain a comprehensive understanding of the underlying mechanisms of APA on chronic pain. Because it is simple, inexpensive, and has no negative side effects, APA can be widely disseminated as an alternative to opioids.

Constraints on Sub-GeV Dark Matter-Electron Scattering from the CDEX-10 Experiment

We present improved germanium-based constraints on sub-GeV dark matter via dark matter-electron (χ-e) scattering using the 205.4  kg·day dataset from the CDEX-10 experiment. Using a novel calculation technique, we attain predicted χ-e scattering spectra observable in high-purity germanium detectors. In the heavy mediator scenario, our results achieve 3 orders of magnitude of improvement for m_{χ} larger than 80  MeV/c^{2} compared to previous germanium-based χ-e results. We also present the most stringent χ-e cross-section limit to date among experiments using solid-state detectors for m_{χ} larger than 90  MeV/c^{2} with heavy mediators and m_{χ} larger than 100  MeV/c^{2} with electric dipole coupling. The result proves the feasibility and demonstrates the vast potential of a new χ-e detection method with high-purity germanium detectors in ultralow radioactive background.

Self-Guided Smartphone Application to Manage Chronic Musculoskeletal Pain: A Randomized, Controlled Pilot Trial

OBJECTIVE

The goal of this study is to evaluate the feasibility and efficacy of an auricular point acupressure smartphone app (mAPA) to self-manage chronic musculoskeletal pain.

METHODS

A prospective, longitudinal, randomized, controlled pilot trial was conducted using a three-group design (self-guided mAPA (n = 14); in-person mAPA (n = 12); and control (n = 11)). The primary outcomes included physical function and pain intensity.

RESULTS

After a 4-week APA intervention, participants in the in-person mAPA group had improved physical function of 32% immediately post-intervention and 29% at the 1M follow-up. Participants in the self-guided mAPA group had higher improvement (42% at post-intervention and 48% at the 1M follow-up). Both mAPA groups had similar degrees of pain intensity relief at post-intervention (45% for in-person and 48% for the self-guided group) and the 1M follow-up (42% for in-person and 45% for the self-guided group). Over 50% of the participants in each group reached at least 30% reduced pain intensity at post-intervention, and this was sustained in the mAPA groups at the 1M follow-up. Approximately 80% of the participants in both mAPA groups were satisfied with the treatment outcomes and adhered to the suggested APA practice; however, participants in the self-guided group had higher duration and more frequency in APA use. The attrition rate was 16% at the 1M follow-up. No adverse effects of APA were reported, and participants found APA to be beneficial and the app to be valuable.

CONCLUSIONS

The study findings indicate that participants effectively learned APA using a smartphone app, whether they were self-guided or received in-person training. They were able to self-administer APA to successfully manage their pain. Participants found APA to be valuable in their pain self-management and expressed satisfaction with the intervention using the app.

Auricular Point Acupressure Smartphone Application to Manage Chronic Musculoskeletal Pain: A Longitudinal, One-Group, Open Pilot Trial

BACKGROUND

Chronic musculoskeletal pain (CMP) is the most common self-reported chronic pain condition. Current treatment for CMP is limited.

METHODS

This was a two-phase study. In Phase 1, three auricular point acupressure (APA)-naïve participants were recruited to explore their experiences of APA and a smartphone app was developed based on their feedback. In Phase 2, a prospective longitudinal study was used to examine the effectiveness of the smartphone app to self-manage CMP.

RESULTS

Phase 1 resulted in the successful development of the APA smartphone app. In Phase 2, after four weeks of APA, participants reported reduced pain intensity (30%), pain interference (35%), and disability (40%), as well as improved physical function (47%). The mean score for the participants' perception of treatment efficacy was 4.94 (SD = 2.08, scale of 0-7) indicating that approximately 70% of participants rated global improvements with noticeable changes. The majority (88%, n = 22) of the participants were satisfied with the treatment: 32% [8] were very satisfied and 56% [n = 14] were somewhat satisfied. The average frequency of pressing APA seeds per day was 2.93 times (SD = 2.27, range 0-10) and 1.60 minutes per time (SD = 2.64, range 0-10); the participants were able to adhere to the suggested pressing time per day, although they only pressed the ear points about 53% of the suggested time.

CONCLUSION

It is feasible for individuals to learn APA from the smartphone app and successfully self-administer APA to manage their pain. Participants found the app useful and were satisfied with the information provided through the app.

Is the combined auriculotherapy approach superior to magneto-auriculotherapy alone in aging males with lower urinary tract symptoms? A randomized controlled trial

The negative impact of lower urinary tract symptoms (LUTS) on affected males is substantial. This study aims to assess whether a combined auriculotherapy (AT) using laser AT (LAT) and magneto-AT (MAT) is more effective than using MAT alone or placebo for managing LUTS of aging males.Methods: A randomized controlled, double-blinded trial was conducted. Sixty-two aging males with moderate or severe LUTS symptoms were randomly allocated into groups: Group 1, placebo LAT plus placebo MAT (n = 20); Group 2, combined AT approach using LAT plus MAT (n = 20); and Group 3, placebo LAT followed by MAT (n = 22). Six ear acupoints assumed to be suitable for alleviating LUTS were used. The total treatment period was 4 weeks, with follow-up visits till 3 months. Generalized estimating equations model was used for the examination of the interactions among the groups over time.Results: A combined AT approach exhibited a stronger treatment effect in relieving voiding problems, improving the peak urinary flow rate, and reducing the post-void residual urine than the placebo group or MAT alone.Conclusions: This study demonstrates that the AT protocol used in this study for aging males with LUTS is feasible and can be adopted in future study of increased scale.

Timing of do-not-resuscitate orders and health care utilization near the end of life in cancer patients: a retrospective cohort study

PURPOSE

The objectives are to explore the prevalence of DNR orders, the factors influencing them, and the association between DNR signing and health care utilization among advanced cancer patients.

METHODS

This was a retrospective cohort study. Data from cancer decedents in three hospitals in China from January 2016 to December 2017 during their last hospitalization before death were obtained from the electronic medical records system.

RESULTS

In total, 427 cancer patients were included; 59.0% had a DNR order. Patients who had solid tumors, lived in urban areas, had more than one comorbidity, and had more than five symptoms were more likely to have DNR orders. The cut-off of the timing of obtaining a DNR order was 3 days, as determined by the median number of days from the signing of a DNR order to patient death. Patients with early DNR orders (more than 3 days before death) were less likely to be transferred to the intensive care unit and undergo cardiopulmonary resuscitation, tracheal intubation, and ventilation, while they were more likely to be given morphine and psychological support compared with those with late (within 3 days before death) and no orders.

CONCLUSIONS

Advanced cancer patients with solid tumors living in urban areas with more symptoms and comorbidities are relatively more likely to have DNR orders. Early DNR orders are associated with less aggressive procedures and more comfort measures. However, these orders are always signed late. Future studies are needed to better understand the timing of DNR orders.

Community canteen services for the rural elderly: determining impacts on general mental health, nutritional status, satisfaction with life, and social capital

BACKGROUND

The Chinese government is piloting canteen services for older adults, but few studies have explored the influence of canteen services on the health of these older adults. This study aimed to investigate the impact of canteen services on older adults' general mental health, nutritional status, satisfaction with life, and social capital in rural areas.

METHODS

This study used a cross-sectional design. We selected 14 villages in Jinhua City, Zhejiang Province, China, including seven villages with canteen services and seven villages without canteen services. Participants were 284 senior older adults (aged 75~98), including 140 residing in villages with canteen services (Canteen Group [CG]) and 144 residing in villages without canteen services (Non-Canteen Group [NCG]). We also divided the CG into two sub-groups according to the funding sources (one receiving government support only, the other receiving government support plus enterprise donations). We used a self-designed questionnaire, including sociodemographics, diet-related items (e.g., satisfaction with the meals, diet expenditure, self-evaluation of meal nutrition), and the four scales including the Chinese version of the 12-item General Health Questionnaire (GHQ-12), the Chinese version of the Mini Nutritional Assessment Short-Form (MNA-SF), the Satisfaction with Life Scale (SWLS), and the Social Capital Questionnaire (SCQ).

RESULTS

The overall mental health, satisfaction with life, and social capital of the CG were better than the NCG (P <  0.05). The nutritional status of these two groups did not show a significant difference. Participants in the CG with financial support from local government and donations from an enterprise with a better dietary diversity exhibited a better nutritional status (P <  0.05); the average satisfaction with diet and self-evaluation of food nutrition of the CG were higher than the NCG (P < 0.05); the ratio of having a diet on time in the CG was higher than that of the NCG (P < 0.05).

CONCLUSION

The free canteen services provided by the government can improve older adults' satisfaction with life and diet, and mental health status and also enrich their social capital, but this still needs to be future evidenced. More financial support for canteen services is an essential component in promoting successful aging in China.

Dynamic Brain Activity Following Auricular Point Acupressure in Chemotherapy-Induced Neuropathy: A Pilot Longitudinal Functional Magnetic Resonance Imaging Study

Background

The objective of this study was to investigate the dynamic brain activity following auricular point acupressure (APA) in chemotherapy-induced neuropathy (CIN).

Methods

Participants received 4 weeks of APA in an open-pilot trial with repeated observation. Along with the clinical self-reported CIN outcomes, objective outcomes were measured over the course of the treatment by physiological changes in pain sensory thresholds from quantitative sensory testing (QST) and repeated functional magnetic resonance imaging scans.

Results

After 4 weeks of APA, participants had reported clinically significant improvements (ie, ≥30%) in a reduction of CIN symptoms (including pain, numbness, tingling, and stiffness) in lower extremity stiffness (32%), reduced foot sensitivity (13%), and higher pain threshold (13%). Across the 11 intrinsic brain networks examined, there was a trend toward significance of the connectivity of the basal ganglia network (BGN) to the salience network (SAL), which was decreased pre-APA versus immediate-APA (effect size [ES] = 1.04, P = .07). The BGN also demonstrated decreased connectivity with the language network pre-APA versus delayed imaging post-APA (ES = −0.92, P = .07). Furthermore, there was increased executive control network (ECN) and SAL within-network connectivity comparing pre-APA to delayed imaging post-APA, trending toward significance (ES = 0.41, P = .09 and ES = 0.17, P = .09, respectively).

Conclusion

The changes in connectivity and activity within or between the ECN, SAL, and BGN from pre- to post-APA suggest ongoing alterations in brain functional connectivity following APA, particularly in the insula, anterior cingulate, and dorsolateral prefrontal cortices, which play significant roles in pain, memory, and cognitive function.

A prospective randomized controlled study of auricular point acupressure to manage chronic low back pain in older adults: study protocol

BACKGROUND

Chronic low back pain (cLBP) is a major health problem and the most common pain condition among those aged 60 years or older in the US. Despite the development of pharmacological and nonpharmacological interventions, cLBP outcomes have not improved and disability rates continue to rise. This study aims to test auricular point acupressure (APA) as a non-invasive, nonpharmacological self-management strategy to manage cLBP and to address current shortcomings of cLBP treatment.

METHODS/DESIGN

For this prospective randomized controlled study, participants will be randomly assigned to three groups: (1) APA group (active points related to cLBP), (2) Comparison group-1 (non-active points, unrelated to cLBP), and (3) Comparison group-2 (enhanced educational control, an educational booklet on cLBP will be given and the treatment used by participants for their cLBP will be recorded). The ecological momentary assessment smartphone app will be used to collect real-time cLBP outcomes and adherence to APA practice. Treatment and nonspecific psychological placebo effects will be measured via questionnaires for all participants. This proposed trial will evaluate the APA sustained effects for cLBP at 12-month follow-up. Monthly telephone follow-up will be used to collect study outcomes. Blood will be collected during study visits at baseline, post APA treatment, and follow-up study visits at 1, 3, 6, 9 and 12 months post completion of treatment for a total of seven assessments. Appointments will start between 9 and 11 am to control for circadian variation in cytokine levels.

DISCUSSION

This study is expected to provide vital information on the efficacy, sustainability, and underlying mechanism of APA on cLBP necessary for APA to gain acceptance from both healthcare providers and patients, which would provide a strong impetus for including APA as part of cLBP management in clinical and home settings.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT03589703. Registered on 22 May 2018.

Symptom distress and interference among cancer patients with osteoradionecrosis of jaw: A cross-sectional study

Objective

Osteoradionecrosis of the jaws (ORNJ) is among the most serious oral complications of head and neck cancer treatment with radiation therapy. This study aimed to examine the level of symptom distress and interference of ORNJ in head and neck cancer patients in China.

Methods

A cross-sectional study was conducted to profile patient reported symptom severity. Ninety-five hospitalized ORNJ patients were recruited. Participants completed the MD Anderson Symptom Inventory–Head and Neck Module-Chinese version.

Results

The percentage of participants who reported that they experienced at least one type of symptom was 97.9%, and 85.2% patients reported interference. The 10 most severe symptoms were as follows: limited mouth opening, problem with teeth/gums, difficulty swallowing/chewing, dry mouth, oral malodor, difficulty with voice/speech, dental ulcer, tinnitus/ear obstruction, skin pain/burning/rash, and difficulty hearing. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. The interference of patients positively correlated with core symptoms (r = 0.612), head and neck symptoms (r = 0.709), and ORNJ symptoms (r = 0.440) (P < 0.01). The longer time to the onset of ORNJ after radiotherapy was positively and significantly correlated with symptom distress (r = 0.479, P < 0.001), and mouth opening correlated negatively with symptom distress (r = −0.298, P = 0.003).

Conclusions

ORNJ patients suffered mainly from limited mouth opening and other maxillofacial symptoms. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. ORNJ patients commonly had symptom distress, which influenced their quality of life.

Sabbatical as a part of the academic excellence journey: A narrative qualitative study

INTRODUCTION

Sabbaticals were first offered by Harvard University in the late 17^th century to provide "renewal" for faculty members. In this period of career development, a professor might learn new techniques, expand a research program, or finish off that book or pile of languishing manuscripts. This article tried to organize lived experiences of a visiting scholar from Isfahan University of Medical Sciences to Johns Hopkins University. The research aimed to study the context and conditions of the sabbatical in an alternative academic setting.

METHODS

This article applies a narrative qualitative study integrated with Eisner critical and connoisseurship approach as a combined naturalistic methodology. Using narrative inquiry and reflective analysis in form of observations and audit reports, written dairy notes and memos, the content analyzed thematically and extracted the themes of lived experiences as well as lessons learned and then have been transformed into tables.

RESULTS

Extracted themes from research sources are categorized into three main themes: organizational and professional experiences; teaching, instruction, and curricular experiences; and research and technology management experiences. These are resulted in the explanation of the field and events (description), discussion about them (interpretation), followed by concluding remarks (evaluation). It also represents research questions and findings in descriptive and interpretation phases.

DISCUSSION AND CONCLUSIONS

This article addresses some descriptions, interpretations, and evaluations extracted from the experiences through answering the research questions. It categorizes these practical lessons into three categories: (1) lessons about becoming a lifelong learner, (2) lessons about remaining a professor, and (3) innovative experiences.

Catheter-directed thrombolysis for patients with acute lower extremity deep vein thrombosis: a meta-analysis

Objectives:

To evaluate case series studies that quantitatively assess the effects of catheter-directed thrombolysis (CDT) and compare the efficacy of CDT and anticoagulation in patients with acute lower extremity deep vein thrombosis (DVT).

Methods:

Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE and Scopus, were searched through January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated with CDT or with anticoagulation. In the case series studies, the pooled estimates of efficacy outcomes for patency rate, complete lysis, rethrombosis and post-thrombotic syndrome (PTS) were calculated across the studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated.

Results:

Twenty-five articles (six comparing CDT with anticoagulation and 19 case series) including 2254 patients met the eligibility criteria. In the case series studies, the pooled results were a patency rate of 0.87 (95% CI: 0.85-0.89), complete lysis 0.58 (95% CI: 0.40-0.75), rethrombosis 0.11 (95% CI: 0.06-0.17) and PTS 0.10 (95% CI: 0.08-0.12). Six studies comparing the efficacy outcomes of CDT and anticoagulation showed that CDT was associated with a reduction of PTS (OR 0.38, 95%CI 0.26-0.55, p<0.0001) and a higher patency rate (OR 4.76, 95%CI 2.14-10.56, p<0.0001).

Conclusion:

Acute lower extremity DVT patients receiving CDT were found to have a lower incidence of PTS and a higher incidence of patency rate. In our meta-analysis, CDT is shown to be an effective treatment for acute lower extremity DVT patients.

Auricular Point Acupressure to Manage Aromatase Inhibitor-Induced Arthralgia in Postmenopausal Breast Cancer Survivors: A Pilot Study

PURPOSE/OBJECTIVES

To assess the feasibility of auricular point acupressure to manage aromatase inhibitor-induced arthralgia.
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DESIGN

Wait list control design.
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SETTING

Outpatient clinics and oncology center.
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SAMPLE

20 women with aromatase inhibitor-induced arthralgia.
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METHODS

After baseline data were collected, participants waited one month before they received acupressure once per week for four weeks at a convenient time. The baseline data served as the control comparison. Self-reported measures and blood samples were obtained at baseline, at preintervention, weekly during the intervention, and at post-intervention.
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MAIN RESEARCH VARIABLES

The primary outcomes included pain intensity, pain interference, stiffness, and physical function. Inflammatory cytokines and chemokines were tested.
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FINDINGS

After the four-week intervention, participants reported decreases in worst pain and pain interference, and improvements in physical function, cancer-related symptom severity, and interference. The proinflammatory cytokines and chemokines displayed a trend of a mean percentage reduction. The anti-inflammatory cytokine interleukin-13 increased from pre- to postintervention.
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CONCLUSIONS

Auricular point acupressure is feasible and may be effective in managing arthralgia in breast cancer survivors.
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IMPLICATIONS FOR NURSING

Nurses can administer acupressure in clinical settings, which could enhance the management of aromatase inhibitor-induced arthralgia and contribute to a shift from traditional disease-based biomedical models to a broader, integrative, medical paradigm for managing aromatase inhibitor-induced arthralgia.

Boerhaave's Syndrome Secondary to Migration of Gastrostomy Tube

Percutaneous endoscopic gastrostomy is a safe procedure for providing nutrition. Complications associated with tube migration such as duodenal obstruction or pancreatitis have been reported. For the first time, we reported a rare complication of gastrostomy tube migration manifested by Boerhaave's syndrome. (Hong Kong j.emerg.med. 2013;20:400-401)

Safety of catheter-directed thrombolysis for the treatment of acute lower extremity deep vein thrombosis: A systematic review and meta-analysis

BACKGROUND

Despite established guidelines, catheter-directed thrombolysis (CDT) for the management of acute lower extremity deep vein thrombosis (DVT) should not be overstated because the risks of CDT are uncertain. We performed a meta-analysis to comprehensively and quantitatively evaluate the safety of CDT for patients with acute lower extremity DVT.

METHODS

Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE, and Scopus, were searched up to January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated by CDT or compared CDT with anticoagulation. In case series studies, the pooled estimates of safety outcomes for complications, pulmonary embolism (PE), and mortality were calculated across studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated.

RESULTS

Of the 1696 citations identified, 24 studies (6 comparing CDT with anticoagulation and 18 case series) including 9157 patients met the eligibility criteria. In the case series studies, the pooled risks of major, minor, and total complications were 0.03 (95% confidence interval [CI]: 0.02-0.04), 0.07 (95% CI: 0.05-0.08), and 0.09 (95% CI: 0.08-0.11), respectively; other pooled risk results were 0.00 for PE (95% CI: 0.00-0.01) and 0.07 for mortality (95% CI: 0.03-0.11). Our meta-analysis of 6 studies comparing the risk of complications and PE related to CDT with those related to anticoagulation showed that CDT was associated with an increased risk of complications (OR = 4.36; 95% CI: 2.94-6.47) and PE (OR = 1.57; 95% CI: 1.37-1.79).

CONCLUSION

Acute lower extremity DVT patients receiving CDT are associated with a low risk of complications. However, compared with anticoagulation, CDT is associated with a higher risk of complications and PE. Rare mortality related to thrombolytic therapy was reported. More evidence should be accumulated to prove the safety of CDT.

Association between Auricular Signals and the Risk Factors of Metabolic Syndrome

Objective: This study aims to determine the association between auricular signals and the risk factors of metabolic syndrome (MS). Methods: A case-control study with an equal number of cases and controls matched by age group and gender was conducted. A total of 204 participants were recruited. Patients were verified as having MS based on the International Diabetes Federation (IDF) criteria. Auricular assessment was conducted in the following sequence: visual inspection, electrical skin resistance test (ESRT), and pressure pain test (PPT). Results: MS+ patients tend to have much more oily auricle complexion than the controls. The ‘endocrine’ (right) of the participants with MS indicated a significantly higher electrical conductivity compared to that of the controls. The MS group participants experienced significant tenderness on the ‘heart’ and ‘endocrine’ acupoints. A number of auricular signals were also associated with the risk factors of MS, including age, gender, smoking status, family history of diabetes, and comorbid illnesses. Both the ‘heart’ and ‘endocrine’ acupoints showed the highest sensitivity to tenderness (60.8%), followed by the ‘endocrine’ (59.8%) and ‘pancreas and gallbladder’ (55.9%). Conclusions: The results of this study suggest that electrical conductivity and tenderness of a number of auricular points, including the ‘heart’, ‘pancreas and gall bladder’, and ‘endocrine’, are associated with MS and its risk factors. Further investigations with a larger sample size could be conducted to verify the value of these auricular signals on MS risk prediction so that this method can be used as an early screening method for the population with a high MS risk.

Pilot Randomized Controlled Trial of Auricular Point Acupressure to Manage Symptom Clusters of Pain, Fatigue, and Disturbed Sleep in Breast Cancer Patients

BACKGROUND

Current management for a symptom cluster of pain, fatigue, and disturbed sleep in breast cancer patients has limited effects.

OBJECTIVE

The purposes of this prospective, randomized controlled pilot study were to (1) assess the feasibility and tolerability of auricular point acupressure (APA) intervention to manage pain, fatigue, and sleep disturbance in breast cancer patients and (2) provide an initial appraisal of effect size as compared with a control intervention.

METHODS

Thirty-one participants were randomized into either an active APA group (n = 16) or a control APA group (n = 15), which included the sham APA treatment not related to the symptoms. All participants received the APA once a week for 4 weeks. Self-report measures were obtained at baseline, weekly during intervention, at end of intervention, and at a 1-month follow-up.

RESULTS

For the 4-week of APA treatment, the retention rate was 88% for the active APA group and 73% for the control APA group. After 4 weeks of APA, participants in the active APA treatment had reported a reduction of 71% in pain, 44% in fatigue, 31% in sleep disturbance, and 61% in interference with daily activities. The control APA group experienced some moderate reduction in these symptoms.

CONCLUSION

Given that this was a pilot study with a small sample size, results must be interpreted with caution.

IMPLICATIONS FOR PRACTICE

Our results suggest that APA may provide an inexpensive and effective complementary approach for the management of symptom clusters for breast cancer patients, and further study is warranted.

Prophylactic Dual Catheter Technique to Prevent Side Branch Snowplowing Complications during Angioplasty and Stenting

Objective

Angioplasty and Stenting of intracranial atherosclerotic lesions have a higher complication rate and a large proportion of this is attributable to side branch arterial occlusion from forceful displacement of the atheroma into the ostia or snowplowing effect. This can result in severe disabilities when it result in small infarcts involving eloquent areas in the posterior circulation or the motor tracts.

Materials and Methods

We present a series of 6 cases utilizing a new dual catheter technique for maintaining the patency of at-risk vessels during angioplasty and stenting. There are several methods previously described to help reduce the incidence of stroke but because they do not have a physical presence in the ostia to protect it, they are unable to guarantee the patency of the vessel.

Results

All 6 patients underwent angioplasty and stenting with the technique. The patients were assessed for complications with post-procedure magnetic resonance imaging and no complications were found.

Conclusion

In this preliminary series, the dual catheter technique appears to safe and effective in preventing occlusion of the adjacent branch arteries. This technique may facilitate the use of the Wingspan stent in the treatment of intracranial atherosclerotic stenotic segments by reducing the risk of peri-procedural stroke.

MRI audit of complications in intracranial stenosis treated with Wingspan device

OBJECTIVES

To evaluate the safety and efficacy of the Wingspan device for the treatment of symptomatic intracranial atherosclerotic stenosis (ICAS).

METHODS

We audited a prospective ongoing database of consecutive patients who received Wingspan stenting between January 2013 and December 2015. All patients underwent MRI to audit any complications during the early follow-up period. We focused on the clinical demographics, lesion characteristics, treatment results, and periprocedural complications. Functional outcomes were measured with the modified Rankin Scale (mRS) at discharge and after 3 months.

RESULTS

Intracranial stenting was performed in 50 patients (100%). Mean stenosis pre-stenting was 76.5±13.1% and post-stenting residual stenosis was 19.8±13.8%. The overall 30-day rate of procedure-related complications was 6.0% (3/50). Two patients (4%) developed in-stent restenosis, one of whom had a dissection at the middle cerebral artery. Interestingly, on the follow-up MRI scan there was a high incidence of asymptomatic diffusion-weighted imaging (DWI) hyperintensities, 46% (23/50) presumed to be due to microembolic causes. At the 90-day, 180-day, and 1-year follow-up, three patients had further strokes resulting in a total complication rate of 12%. 92% had excellent outcomes (mRS 0-1) and only one patient had deterioration of his mRS score.

CONCLUSIONS

ICAS treated by Wingspan stenting using pre-placement balloon angioplasty appears safe and effective with a high technical success rate and favorable outcomes. There is a high incidence of asymptomatic DWI hyperintensites post-procedure, but these do not appear to result in long-term sequelae.

Changes in Sleep With Auricular Point Acupressure for Chronic Low Back Pain

The purpose of this study was to report sleep quality from 4 weeks of auricular point acupressure that was designed for chronic low back pain and determine the relationship between pain intensity and sleep quality. Participants were randomized into the APA group (n = 30) or the sham-APA group (n = 31). At baseline assessment, 87% of the participants reported poor sleep quality. Participants who received APA had decreased daytime disturbance and improved global Pittsburgh Sleep Quality Index scores at end of intervention (EOI) and 1-month follow up compared to participants in the sham-APA group. For the APA group, both the sleep duration and wake after sleep onset decreased gradually during the 4-week APA (0.56% and 0.23% daily change, respectively).

Using auriculotherapy for osteoarthritic knee among elders: a double-blinded randomised feasibility study

Background

Osteoarthritic knee (OA knee) is a common condition in the elderly. Exploration of non-invasive complementary therapies for OA knee is warranted given the limitations of pharmacologic therapies. Auriculotherapy (AT) is a therapeutic method in which specific points on the auricle are stimulated to treat various disorders of the body, and the therapeutic value and synergistic effect of laser auriculotherapy (LAT) when combined with magneto-auriculotherapy (MAT) merits further investigation.

Methods

This study adopted a double-blinded four-arm randomized placebo design. The aims of study are (1) to assess the feasibility of AT among elders with OA knee in a future large-scale study, including the use of blinding in subjects and evaluators, acceptance of treatment protocol, and estimating the effect size and attrition rate; and (2) to evaluate the preliminary effect of AT in elders with OA knee. Subjects were randomly divided into four groups with different modes of AT with/without placebo objects. A total of 43 subjects completed the 6-week intervention and post-assessment. Assessments included a numerical rating scale of pain (NRS), the timed-up-and-go test (TUGT), and standard goniometer measurements during knee flexion and extension, Kruskal–Wallis test was used to evaluate differences among groups, and Wilcoxon sign-ranked test for examining within-group comparison.

Results

Preliminary results indicated the absence of differences in the NRS, TUGT, and active/passive knee flexion and extension at baseline, as well as post-therapy, between the four groups. Even though the differences of these parameters between groups were not significant, the relative differences of NRS and TUGT in subjects who received combined MAT plus LAT were higher than those treated with MAT or LAT alone, or the placebo group. Four of the six parameters demonstrated significant within group differences in subjects who received MAT and/or LAT, whereas no significant differences were found in the placebo group.

Conclusion

This study demonstrates that the AT protocol adopted in this study for elders with OA knee is feasible and could be applied in future larger-scale study. Larger sample size should be considered in a future trial to determine the causal relationship between treatment and effect.

Trial Registration

ClinicalTrials.gov: NCT02352636. Registered on 23 January 2015.

Day-to-Day Changes of Auricular Point Acupressure to Manage Chronic Low Back Pain: A 29-day Randomized Controlled Study

OBJECTIVE

The purpose of this study was to determine the effects of a 4-week auricular point acupressure (APA) treatment on chronic low back pain (CLBP) outcomes and examine the day-to-day variability of CLBP in individuals receiving APA for CLBP over 29 days.

DESIGN

This was a prospective, randomized controlled trial (RCT). Data were collected at baseline, during each of the four office visits for APA treatment, after the completion of the 4-week intervention, and 1 month after the last treatment. A daily diary was given to each participant to record his or her APA practices, analgesic use, and pain intensity.

INTERVENTIONS

APA was used to manage CLBP. The participants received one APA treatment per week for 4 weeks.

PATIENTS AND SETTING

Sixty-one participants with CLBP were randomized into either a real APA or sham APA treatment group. Participants were recruited from primary care offices and clinics or through the Research Participant Registry at the University of Pittsburgh.

RESULTS

Among participants in the real APA group, a 30% reduction of worst pain was exhibited after the first day of APA treatment, and continuous reduction in pain (44%) was reported by the completion of the 4-week APA. This magnitude of pain reduction reached the clinically significant level of improvement reported in other clinical trials of chronic pain therapies. Analgesic use by participants in the real APA group also was reduced compared with use by participants in the sham group.

CONCLUSION

This study shows that APA is a promising pain management strategy that is not invasive and can be self-managed by participants for CLBP. Given the day-to-day fluctuation in ratings, the tighter ecologic assessment of pain scores and other treatment parameters are an important pragmatic aspect of the design of chronic pain studies.

Association of auricular reflective points and the status of lower urinary tract symptoms in aging males

OBJECTIVE

This study aimed to investigate the association between auricular reflective points and the status of lower urinary tract symptoms (LUTS) among Chinese aging males.

METHODS

A total of 113 male participants, with 69 having LUTS (LUTS+ve) and 44 having no LUTS (LUTS-ve), were recruited for this case-control study. Ear diagnosis was conducted in three ways: inspection, electrical skin resistance measurement, and tenderness testing.

RESULTS

Quality of life was lower among the LUTS+ve cases than among the LUTS-ve cases. The tenderness and electrical conductivity of a number of auricular points, including the "angle of superior concha", the "urinary bladder", the "ureter", the "kidney", the "urethra", and the "internal genitals" were associated with LUTS in the Chinese aging males. In terms of electrical conductivity, the "angle of superior concha" on both ears exhibited the highest sensitivity among the other auricular points under testing. This auricular point also demonstrated considerable sensitivity, specificity, and positive/negative predictive values for both ears during the tenderness testing.

CONCLUSIONS

Auricular diagnosis has a pre-diagnostic value and could be considered as a screening method for the aging population with relatively high LUTS risk.

Wired and wireless convergent extended-reach optical access network using direct-detection of all-optical OFDM super-channel signal

We propose and demonstrate the feasibility of using all-optical orthogonal frequency division multiplexing (AO-OFDM) for the convergent optical wired and wireless access networks. AO-OFDM relies on all-optically generated orthogonal subcarriers; hence, high data rate (> 100 Gb/s) can be easily achieved without hitting the speed limit of electronic digital-to-analog and analog-to-digital converters (DAC/ADC). A proof-of-concept convergent access network using AO-OFDM super-channel (SC) is demonstrated supporting 40 - 100 Gb/s wired and gigabit/s 100 GHz millimeter-wave (MMW) ROF transmissions.

Auricular point acupressure as an adjunct analgesic treatment for cancer patients: a feasibility study

This study aimed (1) to examine the feasibility of an auricular point acupressure (APA) research protocol in terms of recruitment and for the assessment and management of pain and (2) to examine the potential APA analgesic effects for cancer patients. This study was a repeated-measures one-group design. Participants were recruited from the cancer center follow-up clinic affiliated with a large university hospital in the northeastern United States. Participants included 50 patients aged 55-87 years with a diagnosis of cancer. Participants received 7 days of APA treatment for their pain. After appropriate acupoints were identified, vaccaria seeds were carefully taped onto each selected auricular point on each ear. The study recruitment and retention rates were 92% and 91%, respectively. Importantly, the study found preliminary evidence for the analgesic effects of APA for cancer pain management. For example, by the end of the 7-day study, APA reduced pain intensity more than 55% for "worst pain" and about 57% for "average pain" and "pain intensity." Moreover, the use of pain medication was reduced during the APA treatment (e.g., 78% of patients [n = 39] took less pain medication than before the treatment). APA appears to be highly acceptable to patients with cancer-related pain. However, without a placebo control, we cannot draw conclusive evidence for the analgesic effect of APA for cancer patients. A sham group must be added to future studies to differentiate the true effects of APA from the possible psychological effects of the APA treatment.

Coding for stable transmission of W-band radio-over-fiber system using direct-beating of two independent lasers

We demonstrate experimentally Manchester (MC) coding based W-band (75 - 110 GHz) radio-over-fiber (ROF) system to reduce the low-frequency-components (LFCs) signal distortion generated by two independent low-cost lasers using spectral shaping. Hence, a low-cost and higher performance W-band ROF system is achieved. In this system, direct-beating of two independent low-cost CW lasers without frequency tracking circuit (FTC) is used to generate the millimeter-wave. Approaches, such as delayed self-heterodyne interferometer and heterodyne beating are performed to characterize the optical-beating-interference sub-terahertz signal (OBIS). Furthermore, W-band ROF systems using MC coding and NRZ-OOK are compared and discussed.

OFDM RF power-fading circumvention for long-reach WDM-PON

We propose and demonstrate an orthogonal frequency division multiplexing (OFDM) radio-frequency (RF) power-fading circumvention scheme for long-reach wavelength-division-multiplexed passive-optical-network (LR-WDM-PON); hence the same capacity of 40 Gb/s can be provided to all the optical-networking-units (ONUs) in the LR-WDM-PON. Numerical analysis and proof-of-concept experiment are performed.

Conduction control at ferroic domain walls via external stimuli

Intriguing functionalities at nano-sized domain walls have recently spawned a new paradigm for developing novel nanoelectronics due to versatile characteristics. In this study, we explore a new scenario to modulate the local conduction of ferroic domain walls. Three controlling parameters, i.e., external electrical field, magnetic field and light, are introduced to the 90° domain walls (90° DWs) of BiFeO₃. Electrical modulation is realized by electrical transport, where the mobility of 90° DWs can be altered by gating voltage. We further use the ferromagnetic/antiferromagnetic coupling to reveal the inherent magnetism at the DWs. With an established magnetic nature, magnetotransport has been conducted to introduce magnetic controlling parameter, where a giant positive magnetoresistance change can be observed up to 200%. In addition, light modulated conduction, a core factor for multifunctional applications, is successfully demonstrated (current enhancement by a factor of 2 with 11 W white lamp). These results offer new insights to discover the tunability of domain wall nanoelectronics.

A scalable and continuous-upgradable optical wireless and wired convergent access network

In this work, a scalable and continuous upgradable convergent optical access network is proposed. By using a multi-wavelength coherent comb source and a programmable waveshaper at the central office (CO), optical millimeter-wave (mm-wave) signals of different frequencies (from baseband to > 100 GHz) can be generated. Hence, it provides a scalable and continuous upgradable solution for end-user who needs 60 GHz wireless services now and > 100 GHz wireless services in the future. During the upgrade, user only needs to upgrade their optical networking unit (ONU). A programmable waveshaper is used to select the suitable optical tones with wavelength separation equals to the desired mm-wave frequency; while the CO remains intact. The centralized characteristics of the proposed system can easily add any new service and end-user. The centralized control of the wavelength makes the system more stable. Wired data rate of 17.45 Gb/s and w-band wireless data rate up to 3.36 Gb/s were demonstrated after transmission over 40 km of single-mode fiber (SMF).

Adaptive 84.44-190 Mbit/s phosphor-LED wireless communication utilizing no blue filter at practical transmission distance

We propose and experimentally demonstrate a white-light phosphor-LED visible light communication (VLC) system with an adaptive 84.44 to 190 Mbit/s 16 quadrature-amplitude-modulation (QAM) orthogonal-frequency-division-multiplexing (OFDM) signal utilizing bit-loading method. Here, the optimal analogy pre-equalization design is performed at LED transmitter (Tx) side and no blue filter is used at the Rx side. Hence, the ~1 MHz modulation bandwidth of phosphor-LED could be extended to 30 MHz. In addition, the measured bit error rates (BERs) of < 3.8 × 10(-3) [forward error correction (FEC) threshold] at different measured data rates can be achieved at practical transmission distances of 0.75 to 2 m.

The impact of abnormal muscle tone from hemiplegia on reclining wheelchair positioning: a sliding and pressure evaluation

BACKGROUND

Little is known about the influence of existing muscle tone abnormality on the sitting posture of stroke patients in reclining wheelchairs.

AIM

To investigate the impact of muscle tone abnormality from hemiplegia on the forward sliding and pressure of stroke patients while sitting in reclining wheelchairs.

DESIGN

Experimental study.

SETTING

The Assistive Devices/Technology Center at the Rehabilitation Department of hospital.

POPULATION

14 able-bodied elders and nonambulatory elderly stroke patients with flaccid (N.=12) or spastic hemiplegia (N.=13) participated in this study. Of the 12 patients with flaccid hemiplegia, 8 suffered from left-sided hemiplegia and 4 from right-sided hemiplegia. Of the 13 patients with spastic hemiplegia, 6 suffered from left-sided hemiplegia and 7 from right-sided hemiplegia.

METHODS

We performed 3 reclining cycles in wheelchairs with conventional seats and V-shaped seats for each participant. The sliding along the backrest (BS) plane and the seat (SS) plane, mean sitting pressure (MP), and sacral peak pressure (SPP) of the participants were recorded. The Kruskal-Wallis test was used to compare the difference in BS, SS, MP, and SPP between able-bodied elders and stroke patients.

RESULTS

The BS, SS, and SPP during repetitive reclining were generally greatest in flaccid hemiplegic participants, followed by spastic hemiplegic participants, and finally by able-bodied participants. There was no significant difference in MP among three subject groups on both conventional seats and V-shaped seats in most comparisons. Able-bodied participants' buttocks tended to slide forward on conventional seats but backward on V-shaped seats, whereas hemiplegic participants' buttocks slid forward on both seat types.

CONCLUSION

Stroke patients with flaccid hemiplegia are the most vulnerable to sacral sitting and higher sacral pressure in reclining wheelchairs, followed by patients with spastic hemiplegia. There is a difference in the displacement pattern between participants with normal muscle tone and those with abnormal muscle tone during wheelchair positioning. People who have hemiplegia with spasticity do not have incremental forward sliding with repetitive reclining in the same way as those who have a flaccid hemiplegia.

CLINICAL REHABILITATION IMPACT

The findings are valuable for wheelchair prescription and caregiver education.

Stable and wavelength-tunable silicon-micro-ring-resonator based erbium-doped fiber laser

In this work, we propose and demonstrate a stable and wavelength-tunable erbium-doped fiber (EDF) ring laser. Here, a silicon-on-insulator (SOI)-based silicon-micro-ring-resonator (SMRR) is used as the wavelength selective element inside the fiber ring cavity. A uniform period grating coupler (GC) is used to couple between the SMRR and single mode fiber (SMF) and serves also as a polarization dependent element in the cavity. The output lasing wavelength of the proposed fiber laser can be tuned at a tuning step of 2 nm (defined by the free spectral range (FSR) of the SMRR) in a bandwidth of 35.2 nm (1532.00 to 1567.20 nm), which is defined by the gain of the EDF. The optical-signal-to-noise-ratio (OSNR) of each lasing wavelength is larger than 42.0 dB. In addition, the output stabilities of power and wavelength are also discussed.

Reduction in nausea and vomiting in children undergoing cancer chemotherapy by either appropriate or sham auricular acupuncture points with standard care

BACKGROUND

Over 40% of children with cancer have reported that chemotherapy-induced nausea and vomiting (CINV) are the two most distressing side-effects of treatment even when antiemetic drugs have been used.

OBJECTIVES

The purpose of this article is to report the findings from a feasibility and pilot study using auricular point acupressure point for CINV in a small group of children in Taiwan.

METHODS

This was a crossover randomized design study. CINV symptoms were assessed on 10 patients just prior to and for 7 days following each of three rounds of chemotherapy drugs (CTX). They received standard care (SC) and were not entered into a test treatment group until they completed the baseline assessment, which was conducted during their first round of chemotherapy after entering the study. Just prior to receiving the second round of CTX, patients were randomized into one of two treatment conditions: auricular acupressure intervention, in addition to standard care (AAP) or auricular acupressure using sham auricular points (SAP) in addition to standard care. For the third round of CTX, they were switched to the other treatment group.

RESULTS

The enrollment rate for this study was 77% of the children invited to participate and of those, 88% provided completed data sets for all three treatment conditions. Patients in the AAP group reported significantly lower occurrence and severity of nausea and vomiting than patients in the SC group (p<0.05). There were no significant differences of nausea and vomiting for patients between the AAP and SAP groups. All of the patients took antiemetic medication on the day they received CTX, and 80% of patients reported that the antiemetics did not help to treat CINV.

CONCLUSIONS

These preliminary findings did show evidence that AAP is acceptable to the children and their parents to prevent/treat CINV. However, there were no statistically significant differences between the AAP and SAP groups in the prevention/treatment of CINV. There were clinical trend differences between the groups, which may due to the small sample size. In a larger study, it would be important to determine whether the effects of the AAP and SAP treatment are independent of any psychologic effects, such as the researcher's increased presence in both treatment groups.

Timing of gangrene tissue debridement after autologous bone marrow cell implantation in patients with superficial femoral arterial occlusion: preliminary experiences

AIM

Although implantation of bone marrow mononuclear cells (BMI) was shown to improve outcomes in patients with severe peripheral arterial occlusive disease (PAOD), little experience has been reported in patients with an arterial occlusion level above the knee, ischemic gangrene, and high cardiovascular risk. This study sought to investigate the timing of gangrene tissue debridement and the safety of BMI in these patients.

METHODS

Six "no-option" PAOD patients were enrolled with an arterial occlusion level above the knee, ischemic gangrene, and 3 systemic diseases related to a high cardiovascular risk. The ischemic status was evaluated by measuring the ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), and wound healing after BMI.

RESULTS

All patients safely underwent the procedures with intravenous general anesthesia by titrating propofol. Major lower extremity amputation, minor debridement amputation, and debridement surgery were performed in 2 (33.3%), 1 (16.7%), and 2 (33.3%) patients, respectively, 3.1 2.8 months after BMI. Compared to the amputation group (N=3), the salvage group (N=3) had a significantly higher baseline ABI (P=0.02) and a shorter distance between the gangrene site and arterial occlusion site (P=0.01). In the 3 patients who underwent debridement, ABI and TcPO2 significantly improved 1 month after BMI, and gangrenous tissues were debrided 3.8 ± 3.6 (range, 1~8) months after BMI with complete healing within 1 month.

CONCLUSION

Autologous BMI therapy is safe in patients at high cardiovascular risk with an arterial occlusion level above the knee and ischemic gangrene. Effective predictors of BMI include the baseline ABI and distance to the ischemia. Gangrene tissue should be debrided at least 1 month after BMI.

Removal of C.I. Reactive Red 2 from aqueous solutions by chitin: an insight into kinetics, equilibrium, and thermodynamics

In this study, C.I. Reactive Red 2 (RR2) was removed from aqueous solutions by chitin. Exactly how the RR2 concentration, chitin dosage, pH, and temperature affected adsorption of RR2 by chitin was then determined. After reaction for 120 min, the amount of 10 and 20 mg/L RR2 absorbed onto chitin was 5.7 and 7.5 mg/g, respectively. The adsorption percentage increased from 56 to 94% when the chitin dosage was increased from 1.5 to 2.5 g/L. Experimental results indicated that the pseudo-second-order model best represents adsorption kinetics. Adsorption of RR2 increased as the temperature increased; however, it decreased with an increased pH. Experimental results further demonstrated that the Freundlich model is superior to the Langmuir model in fitting experimental isotherms. The ΔH° and ΔS° were 16.34 kJ/mol and 152.10 J/mol K, respectively. ΔH° suggested that adsorption of RR2 onto chitin was via physisorption.

Using adaptive four-band OFDM modulation with 40 Gb/s downstream and 10 Gb/s upstream signals for next generation long-reach PON

In this demonstration, we propose and demonstrate an adaptive long-reach passive optical network (LR-PON) using four-band orthogonal frequency division multiplexed (OFDM) channels. The downstream traffic rates from 6.25 to 40 Gb/s (using fixed quadrature amplitude modulation (QAM) level in the four OFDM bands) and from 9.37 to 40.3 Gb/s (using variable QAM levels in the four OFDM bands) can be achieved adaptively in the optical network units (ONUs) depending on different fiber transmission lengths from 0 to 100 km. For the upstream transmission, a 10 Gb/s 16-QAM OFDM signal with pre-emphasis is experimentally performed by using a 2.5 GHz directly modulated laser (DML). Based on the simulation and experimental results, the proposed adaptive four-band OFDM system could be a promising candidate for the future LR-PON.

Imaging findings in mandibular primitive neuroectodermal tumour: a report of a rare case and review of the literature

Primitive neuroectodermal tumours (PNETs) are aggressive undifferentiated tumours that occur mainly in the central nervous system (CNS). Reviewing the literature, only six cases of primary PNET of the mandible have been reported. These rare tumours are usually overlooked in clinical practice. An 18-year-old woman who presented with dental caries and left cheek swelling was initially diagnosed with facial cellulitis, but the swelling persisted despite adequate intravenous antibiotic therapy. Subsequent ultrasound and MR examinations revealed a tumour originating from the left mandibular ramus. The ultrasonography-guided percutaneous core needle biopsy confirmed the diagnosis of peripheral PNET. The radiographic features of mandibular PNETs are similar to those of PNETs in other regions, except for haemorrhage, necrosis and calcification. In addition, this is the first reported case with sonographic and MR images of this rare tumour, and the first case that was diagnosed based on the ultrasonography-guided percutaneous core needle biopsy. Using these image characteristics, mandibular PNETs can be diagnosed more accurately.

Long-reach radio-over-fiber signal distribution using single-sideband signal generated by a silicon-modulator

The integration of passive optical network (PON) and radio-over-fiber (ROF) networks could provide broadband services for both fixed and mobile users in a single and low-cost platform. Combining the long-reach (LR)-PON (>100 km) and the LR-ROF can further reduce the cost by simplifying the network architecture, sharing the same optical components and extending the coverage of ROF network. However, the transmission and distribution of ROF signal in LR network is very challenging due to the chromatic dispersion generated periodic power fading and code time-shifting effects in the optical fiber. In this work, we propose and experimentally demonstrate a LR-ROF signal distribution using single-sideband (SSB)-ROF signal generated by a silicon ring-modulator. The silicon modulator is compact and has low power consumption. Besides, one unique feature of the silicon ring-modulator is that it only modulates the signal wavelength at the resonant null. This makes it very suitable for the generation of the SSB-ROF signal. Numerical comparison of the SSB-ROF with the double-sideband (DSB)-ROF and optical carrier suppress (OCS)-ROF signals; as well as the fabrication of the silicon ring-modulator will be discussed.

Analysis of the carrier-suppressed single-sideband modulators used to mitigate Rayleigh backscattering in carrier-distributed PON

By using the carrier-suppressed single-sideband (CS-SSB) modulation, the Rayleigh backscattering (RB) experienced by the uplink signal can be effectively mitigated due to the reduction of the spectral overlap between the uplink signal and the distributed optical carrier. In this work, we first introduce the theoretical analysis of the CS-SSB generation using the dual-drive MZM (DD-MZM)-based and a dual-parallel MZM (DP-MZM)-based optical networking units (ONUs). Due to the different modulation mechanisms of the two CS-SSB modulations, the frequency components of the generated CS-SSB signals are also different. The transmission performance and the dispersion tolerance of the uplink signals generated by the two CS-SSB modulators are also analyzed and discussed.

Heterogeneous radio-over-fiber passive access network architecture to mitigate Rayleigh backscattering interferometric beat noise

We propose and experimentally demonstrate a hybrid radio-over-fiber (ROF) wavelength division multiplexed and time division multiplexed passive optical network (WDM-TDM PON) architecture to mitigate Rayleigh backscattering (RB) interferometric beat noises. Here, only a single wavelength is needed at the central office (CO) to generate the downstream baseband data for optical wired application and optical millimeter-wave (mm-wave) signal for wireless application. The upstream signal is produced by remodulating the downstream signal. No optical filter is required at the optical network unit/remote antenna unit (ONU/RAU) to separate the optical wired and optical mm-wave signals. In the proposed network, 10 Gb/s differential phase shift keying (DPSK) signal is used for the downstream optical wired application and 2.5 Gb/s on-off keying (OOK) signal on 20 GHz carrier is used for the optical mm-wave signal. In each ONU, a reflective optical semiconductor amplifier (RSOA) is used to remodulate and produce a 2.5 Gb/s OOK format for upstream traffic. As the back-refection produced by the downstream DPSK signal and the upstream OOK signal is traveling in different fiber path, RB noise at the CO can be completely mitigated.

Mitigation of Rayleigh backscattering in 10-Gb/s downstream and 2.5-Gb/s upstream DWDM 100-km long-reach PONs

Long-reach passive optical network (LR-PON) is considered as a promising technology towards higher capacity and extended coverage optical system. We propose and demonstrate a LR-PON with the capability of Rayleigh backscattering (RB) noise mitigation. By using the upstream signal wavelength-transition generated by a dual-parallel Mach-Zehnder modulator (DP-MZM) based colorless optical networking unit (ONU), the spectral overlap among the upstream signal and the RB noises can be minimized. Hence, due to the achievement of effective RB mitigation, a 100 km LR-PON with a high split-ratio of 512 is demonstrated using 10 Gb/s non-return-to-zero (NRZ) downstream and 2.5 Gb/s NRZ upstream signals. Detail analysis of the wavelength-transition generation is presented.