Defocused and Radial Shock Wave Therapy, Mesotherapy, and Kinesio Taping Effects in Patients with Lipedema: A Pilot Study

The aim of this pilot study was to investigate the effects of defocused and radial shock wave therapy, mesotherapy, and kinesio taping on pain, circumferences of lower limbs, echographic/ elastosonographic pattern of subcutaneous adipose tissue (SAT), and quality of life in patients with lipedema. Fifteen women affected by lower limb lipedema in stage II were treated with shock wave therapy, mesotherapy, and kinesio taping on thighs and legs (eight sessions, twice a week). The primary outcome was pain, as assessed by Numeric Rating Scale (NRS). Secondary outcomes included the limb circumferences measurements, the SF-12 Health Survey for quality of life, the International Classification of Functioning (ICF) for disability, and echographic/ elastosonographic changes of SAT. Significant reductions of pain and circumference measurements were seen in patients at each follow up. This was associated with significant reduction of thickness, echographic pattern improvement, and increased elasticity of SAT, with consequent positive impact on the quality of life and disability reported by the patients. The results demonstrate improved clinical and functional ultrasound findings in patients affected by lipedema in the early stages of lower limbs, and this combination therapy needs to be investigated in larger populations at multiple centers to confirm the findings.

Nonvitamin K-dependent oral anticoagulants (NOACs) in chronic kidney disease patients with atrial fibrillation

Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD patients AF is associated with an increased risk of thromboembolism and stroke. However, CKD patients, especially those on renal replacement therapy (RRT), also exhibit an increased risk of bleeding, especially from the gastrointestinal tract. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF presenting increased risk of stroke. Limited evidence on efficacy, the increased risk of bleeding as well as some concern regarding the use of warfarin in CKD, has often resulted in the underuse of anticoagulation CKD patients. A large body of evidence suggests that non-vitamin K-dependent oral anticoagulant agents (NOACs) significantly reduce the risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with vitamin K antagonist such as warfarin in normal renal function subjects. Hence, they are currently recommended for patients with atrial fibrillation at risk for stroke. However, NOACs metabolism is largely dependent on the kidneys for elimination and little is known in patients with creatinine clearance <25ml/min who were excluded from all pivotal phase 3 NOACs trials. This review focuses on the current pharmacokinetic, observational, and prospective data on NOACs in patients with moderate to advanced chronic kidney disease (creatinine clearance 15-49ml/min) and those on dialysis.

Perceptive rehabilitation of patients with non-specific chronic low back pain: the role of body midline. A randomized controlled trial

BACKGROUND

Surface for perceptive rehabilitation (Su-Per treatment) is a hopeful therapeutic system in the treatment of non-specific chronic low back pain (CLBP). During treatment, some patients poorly tolerate the presence of the less elastic cones at the back midline.

AIM

To assess the importance of an increased awareness of body midline through higher stimulus at interspinous line during Su-Per treatment for non-specific CLBP.

DESIGN

Single-blind, randomized, controlled trial.

SETTING

Outpatient academic hospital.

POPULATION

Forty patients with non-specific CLBP, for at least 12 weeks before treatment.

METHODS

The patients were distributed in 2 groups: Group A (20 patients) received standard Su-Per treatment; Group B (20 patients) received Su-Per treatment without higher stimulus at interspinous line. Pain was assessed using the Visual Analogue Scale and the Present Pain Intensity and Pain Rating Index of the McGill Pain Questionnaire. Disability was evaluated using the Oswestry Disability Index.

RESULTS

In both groups, a significant reduction of pain and disability scores was observed at the first follow-up (end of treatment), and was maintained at later evaluations (4-weeks, and 12-weeks follow up). No significant difference was observed between the two groups in all outcome measures at all time points (P>0.05 for all).

CONCLUSION

Su-Per treatment is a valid modality in a cognitive-perceptive therapeutic concept for non-specific CLBP. It does not necessarily require external stimulation of the body midline to be effective.

CLINICAL REHABILITATION IMPACT

Modifying the standard distribution of the cones, without less deformable cones along interspinous line, makes the Su-Per treatment more acceptable to patients.