Retention of tissue texture change after cervical muscle energy and high velocity low amplitude intervention: implications for treatment intervals

CONTEXT

When choosing to incorporate osteopathic manipulative treatment (OMT) into a patient's care, the risk-to-benefit ratio, the choice of treatment technique, as well as the frequency of treatments are always taken into consideration. This has been even more important during the COVID-19 pandemic, in which social distancing has been the best preventative measure to decrease exposure. By increasing treatment intervals, one could not only limit possible exposure/spread of viruses but also decrease the overall cost to the system as well as to the individual. This is an expansion of a previous study in which quantifiable changes in cervical hysteresis characteristics post-OMT were documented utilizing a durometer (Ultralign SA201^®; Sigma Instruments; Cranberry, PA USA). This study compared two treatment modalities, muscle energy (ME) and high-velocity low-amplitude (HVLA) postcervical treatment. Subjects in this study were allowed to re-enroll, provided that they could be treated utilizing the alternate treatment modality. By allowing repeat subjects, analysis of the data for lasting effects of OMT could be observed.

OBJECTIVES

To determine whether a significant change in cervical hysteresis would be observed after each treatment regardless of a short treatment interval.

METHODS

A total of 34 subjects were retrospectively noted to be repeat subjects from a larger, 213-subject study. These 34 subjects were repeat participants who were treated with two different direct-treatment modalities 7-10 days apart. Each subject was randomly assigned to receive a single-segmental ME or HVLA treatment technique directed toward a cervical (C) segment (C3-C5 only). Subjects were objectively measured pretreatment in all cervical segments utilizing the Ultralign SA201^®, then treated with cervical OMT to a single segment, and finally reassessed at all cervical levels with the Ultralign SA201^® posttreatment to assess for change in cervical hysteresis.

RESULTS

Statistically significant or suggestive changes (p-values 0.01-0.08) with good clinical effect size (0.30 or greater) were noted in all four components of the Ultralign SA201^® at multiple cervical levels after the first treatment, but only one component (frequency) had a statistically significant change after the second treatment (AA cervical level, p-value 0.01) with good clinical effect size (0.45). However, when comparing the post-first-treatment values to the pre-second-treatment values, no statistically significant differences (p-value 0.10 or higher) were observed between them.

CONCLUSIONS

Statistically significant changes were noted after the first treatment; however, when comparing cervical hysteresis changes after the first treatment to the cervical hysteresis values prior to the second treatment delivered 7-10 days later, there were no statistically significant or suggestive changes. This data suggest that several post-OMT changes noted after the first treatment were still in effect and may indicate that follow-up visits for direct manipulation may be deferred for a least two weeks.

Excessive heat-associated gingival necrosis: a case report

Heat-delivery devices have been associated with relatively high temperatures. Previous basic research studies suggest that the risk for periodontal tissues is negligible, as the presence of the root filling materials, amongst other factors, reduce the risk of overheating. This report describes the case of a 45 year old male, who was undergoing restorative treatment in a multi-specialty dental practice. As part of his overall treatment planning, orthograde root canal retreatment for his maxillary left incisor teeth was deemed necessary, due to chronic apical periodontitis. Following cold lateral compaction, the coronal portion of the core material was severed using a System B Heat Source (Kerr Dental, Orange, CA, USA), with the patient reporting pain as well as a burning sensation. The following day the patient was seen by a periodontist and gingival necrosis in relation to the central incisor was found. The most likely cause of the complication was considered to be excessive heat during the operative procedure. The patient was followed up for a 2-year period and the soft tissues returned to their original condition without the need for periodontal treatment.

A comparative study of cervical hysteresis characteristics after various osteopathic manipulative treatment (OMT) modalities

BACKGROUND

Few objective measures have been used to document change in myofascial tissues after OMT.

HYPOTHESIS

Paraspinal tissues associated with cervical somatic dysfunction (SD) will demonstrate quantifiable change in myofascial hysteresis characteristics after a given OMT technique but not after a Sham intervention.

MATERIALS & METHODS

240 subjects were palpated for cervical articular SD. A randomly selected intervention (5 OMT techniques or a Sham) was applied to the cervical SD clinically considered to be most severe. A durometer (SA201(®); Sigma Instruments, Cranberry, PA, USA) objectively measured myofascial structures overlying each cervical spinal segment pre- and post- intervention. Using a single consistent piezoelectric impulse, this durometer quantified four hysteresis (tissue texture) characteristics--fixation, mobility, frequency, and motoricity.

RESULTS

Baseline changes in median hysteresis values were noted for each OMT technique but not for Sham interventions. Notably, segmental counterstrain OMT resulted in significant motoricity change compared to adjacent segmental myofascial measures (p-value 0.04) along with a suggestive trend in the mobility component (p-value 0.12).

CONCLUSION

When comparing treated to untreated cervical segments, the most significant change occurred post-counterstrain OMT with no overall change following Sham. Overall, quantifiable objective change occurs in myofascial tissues post-OMT, in addition to the noted clinical palpable change.

Effects of tillage and phosphorus placement on phosphorus runoff losses in a grain sorghum-soybean rotation

Phosphorus enhances eutrophication of fresh water bodies. This study was conducted to determine the influence of tillage and P placement on P losses in runoff water from a somewhat poorly drained soil (Woodson silt loam [fine, smectitic, thermic Abruptic Argiaquoll], 1.0-1.5% slope) in a grain sorghum [Sorghum bicolor (L.) Moenchl-soybean [Glycine mar (L.) Merr] rotation. Chisel-disk-field cultivate (ChT), ridge-till (RT), and no-till (NT) in combination with 0 kg P ha(-1) or 24 kg P ha(-1) broadcast or knifed (applied prior to planting grain sorghum) were studied. Runoff volume and losses of sediment and P were summed over the growing season. Significant interactions between tillage and P placement for soluble P losses were found. For example, soluble P loss in 1999 for NT-broadcast in grain sorghum was 358 g ha(-1); significantly greater than 31 g ha(-1) for NT-knife or 23 g ha(-1) for NT-check. Similar results were found for RT but no such differences were found for ChT. Bioavailable P losses were generally highest with broadcast P placement and for NT and RT. Total P losses were significantly higher at 959 g ha(-1) with broadcast P on grain sorghum in 1998, compared with 521 g ha(-1) for the check and 659 g ha(-1) for the knifed P applications. Total P losses in 1999 for soybeans were only 18 g ha(-1) for NT, which was significantly lower than 75 g ha(-1) for ChT and 66 g ha(-1) for RT. The results indicate that broadcast P applications on RT and NT will increase P losses, but the influence of tillage was not consistent.

Watershed monitoring to address contamination source issues and remediation of the contaminant impairments

The Big Blue River Basin is located in southeastern Nebraska and northeastern Kansas and consists of surface water in the Big Blue River, Little Blue River, Black Vermillion River, and various tributaries draining 24,968 km2. Approximately 75% of the land area in the basin are cultivated cropland. The Big Blue River flows into Tuttle Creek Reservoir near Manhattan, Kansas. Releases from the lake are used to maintain streamflow in the Kansas River during low flow periods, contributing 27% of the mean flow rate of the Kansas River at its confluence with the Missouri River. Tuttle Creek Reservoir and the Kansas River are used as sources of public drinking water and meet many of the municipal drinking water supply needs of the urban population in Kansas from Junction City to Kansas City. Elevated concentrations of pesticides in the Big Blue River Basin are of growing concern in Kansas and Nebraska as concentrations may be exceeding public drinking water standards and water quality criteria for the protection of aquatic life. Pesticides cause significant problems for municipal water treatment plants in Kansas, as they are not appreciably removed during conventional water treatment processes unless activated carbon filtering is used. Pesticides have been detected during all months of the year with concentrations ranging up to 200 microg/l. If high concentration in water is associated with high flow conditions then large mass losses of pesticides can flow into the water supplies in this basin. This paper will investigate the use of a monitoring program to assess the non-point source of this atrazine contamination. Several practices will be examined that have shown ability to remediate or prevent these impairments.

Management course

As part of a Management course we are researching recruitment and retention of trained nursing staff.

Actinomycin D in the treatment of advanced breast cancer

Actinomycin D is generally administered by serial low-dose injection over 5-10 days. Recent recognition of prolonged serum and tissue half-lives suggests that high-dose intermittent injecton should be equally effective and less toxic. An intermitten single dose schedule was selected for this phase II trial of actinomycin D in 23 patients with advanced breast cancer refractory to standard combination chemotherapy. The drug was given in doses of 0.75-1.5 mg/m2 at 2-week intervals or on days 1 and 8 of 28-day treatment cycles. One patient obtained a partial response with a duration of 5.7 months. Four patients experienced stabilization of advanced disease, with a mean duration of response of 6.4 months. Gastrointestinal toxicity occurred in 47% of patients and mild to moderate myelosuppression in 39%. We conclude that actinomycin D in this dosage and schedule has limited activity in advanced breast cancer. Higher doses might result in increased response rates but would be associated with greater toxicity.

Radionuclide scanning in patients with advanced malignant melanoma

The results of liver, bone, and brain scans in 84 patients with recurrent or metastatic malignant melanoma were reviewed. The liver scan was initially positive in 18% (14/78) and ultimately in 32% (25/78). Serum alkaline phosphatase and lactic dehydrogenase were elevated in 92%. These patients ultimately developed positive liver scans, while convincing hepatomegaly was noted in only 44%. Bone scans were eventually positive in 33% (16/49), all of whom had pain. Brain scans were positive in 15% (10/65), all of whom had CNS symptoms. In asymptomatic patients, bone and brain scans only rarely disclosed occult lesions.