The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles

DESIGN: A randomized controlled trial.OB JECTIVE: To investigate the immediate effects on pressure pain thresholds over latent trigger points (TrPs) in the masseter and temporalis muscles and active mouth opening following atlanto-occipital joint thrust manipulation or a soft tissue manual intervention targeted to the suboccipital muscles. BACKGROUND : Previous studies have described hypoalgesic effects of neck manipulative interventions over TrPs in the cervical musculature. There is a lack of studies analyzing these mechanisms over TrPs of muscles innervated by the trigeminal nerve. METHODS: One hundred twenty-two volunteers, 31 men and 91 women, between the ages of 18 and 30 years, with latent TrPs in the masseter muscle, were randomly divided into 3 groups: a manipulative group who received an atlanto-occipital joint thrust, a soft tissue group who received an inhibition technique over the suboccipital muscles, and a control group who did not receive an intervention. Pressure pain thresholds over latent TrPs in the masseter and temporalis muscles, and active mouth opening were assessed pretreatment and 2 minutes posttreatment by a blinded assessor. Mixed-model analyses of variance (ANOVA) were used to examine the effects of interventions on each outcome, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. RESULTS: The 2-by-3 mixed-model ANOVA revealed a significant group-by-time interaction for changes in pressure pain thresholds over masseter (P<.01) and temporalis (P =.003) muscle latent TrPs and also for active mouth opening (P<.001) in favor of the manipulative and soft tissue groups. Between-group effect sizes were small. CONCLUSIONS: The application of an atlanto-occipital thrust manipulation or soft tissue technique targeted to the suboccipital muscles led to an immediate increase in pressure pain thresholds over latent TrPs in the masseter and temporalis muscles and an increase in maximum active mouth opening. Nevertheless, the effects of both interventions were small and future studies are required to elucidate the clinical relevance of these changes. LEVEL OF EVIDENCE : Therapy, level 1b. J Orthop Sports Phys Ther 2010;40(5):310-317. doi:10.2519/jospt.2010.3257. KEYWORDSDS: cervical manipulation, muscle trigger points, neck, TMJ, upper cervical.

Alternative regimens for prostate cancer treatment using radiation therapy

Purpose/Objective: The purpose of this work was to determine biologically equivalent alternative regimens for the treatment of prostate cancer using External Beam Radiotherapy (EBRT) and Low Dose-Rate Brachytherapy (LDRBT) with 125I implants and to evaluate the sensitivity of these regimens to different sets of radiobiological parameters of the Linear-Quadratic (LQ) model.

Radiographers and radiation protection: education, training and CPD

The increasing use of ionizing radiation for medical purposes emphasizes the concern about safety and justification of using ionizing radiation. This is linked with the use of new and high-dose X-ray technology (particularly CT). According to the UNSCEAR 2010 Report the total number of diagnostic medical examinations (both medical and dental) is estimated to have risen from 2.4 billion (period 1991–1996) to 3.6 billion (period 1997– 2008) - a marked increase in collective doses. An appropriate use of technology aiming diagnostic or therapy and respecting the ALARA principle is a mandatory requisite to safely perform any radiological procedure. Radiation protection is thus, a concern of all specialists in the radiology field ( radiologists, radiographers, medical physicists, among other professional groups). The importance of education and training of these professionals in reducing patients’ doses while maintaining the desired level of quality in medical exposures, as well as precise therapeutic treatments is well recognized. Education, training and continuing professional development (CPD) constitute a triad pointing towards the radiographers’ development of competences in the radiation protection field. This presentation excludes the radiographer role and competences in the fields of ultrasonography and MRI.

New syntheses of potential biologically active xanthones and benzoxanthones

10º Encontro Nacional de Química Orgânica e 1º Simpósio Luso-Brasileiro de Química Orgânica, Lisboa, 4-6 Setembro de 2013.

SiC Multilayer Structures as Light Controlled Photonic Active Filters

Tunable wavelength division multiplexing converters based on amorphous SiC multilayer photonic active filters are analyzed. The configuration includes two stacked p-i-n structures (p(a-SiC:H)-i'(a-SiC:H)-n(a-SiC:H)-p(a-SiC:H)-i(a-Si:H)-n(a-Si:H)) sandwiched between two transparent contacts. The manipulation of the magnitude is achieved through appropriated front and back backgrounds. Transfer function characteristics are studied both theoretically and experimentally. An algorithm to decode the multiplex signal is established. An optoelectronic model supports the optoelectronic logic architecture. Results show that the light-activated device combines the demultiplexing operation with the simultaneous photodetection and self-amplification of an optical signal. The output waveform presents a nonlinear amplitude-dependent response to the wavelengths of the input channels. Depending on the wavelength of the external background and irradiation side, it acts either as a short- or a long-pass band filter or as a band-stop filter. A two-stage active circuit is presented and gives insight into the physics of the device.

Optimal design for active damping in sandwich structures using the Direct MultiSearch method

This paper addresses the problem of optimal positioning of surface bonded piezoelectric patches in sandwich plates with viscoelastic core and laminated face layers. The objective is to maximize a set of modal loss factors for a given frequency range using multiobjective topology optimization. Active damping is introduced through co-located negative velocity feedback control. The multiobjective topology optimization problem is solved using the Direct MultiSearch Method. An application to a simply supported sandwich plate is presented with results for the maximization of the first six modal loss factors. The influence of the finite element mesh is analyzed and the results are, to some extent, compared with those obtained using alternative single objective optimization. (C) 2013 Elsevier Ltd. All rights reserved.

A 5GHz/1.8V CMOS Active Balun Integrated with LNA

The development of high performance monolithic RF front-ends requires innovative RF circuit design to make the best of a good technology. A fully differential approach is usually preferred, due to its well-known properties. Although the differential approach must be preserved inside the chip, there are cases where the input signal is single-ended such as RF image filters and IF filters in a RF receiver. In these situations, a stage able to convert single-ended into differential signals (balun) is needed. The most cited topology, which is capable of providing high gain, consists on a differential stage with one of the two inputs grounded. Unfortunately, this solution has some drawbacks when implemented monolithically. This work presents the design and simulated results of an innovative high-performance monolithic single to differential converter, which overcomes the limitations of the circuits.The integration of the monolithic active balun circuit with an LNA on a 0.18μm CMOS process is also reported. The circuits presented here are aimed at 802.11a. Section 2 describes the balun circuit and section 3 presents its performance when it is connected to a conventional single-ended LNA. Section 4 shows the simulated performance results focused at phase/amplitude balance and noise figure. Finally, the last section draws conclusions and future work.

Results of radiation protection programmes on mammography

In this paper, we present the results of mammography quality control tests related to the work with Portuguese mammography equipment, either in conventional or in digital mammography computed radiography, showing the main differences in the tested equipments. Quality control in mammography is a very special area of quality control in radiology, which demands relatively high knowledge on physics. Digital imaging is changing the standards of the radiographic imaging. Regarding mammography, this is yet a controversial issue owing to some limitations of the digital detectors, like the resolution for instance. A complete set of results regarding radiation protection of the patients submitted to mammography diagnosis is presented. A discussion of the quality image parameters and its interpretation in conventional and digital mammography is presented. In conclusion, we present a sample of results that can be considered as characteristics of mammography equipment in Portugal.

Comparison of different breast planning techniques and algorithms for radiation therapy treatment

This work aims at investigating the impact of treating breast cancer using different radiation therapy (RT) techniques – forwardly-planned intensity-modulated, f-IMRT, inversely-planned IMRT and dynamic conformal arc (DCART) RT – and their effects on the whole-breast irradiation and in the undesirable irradiation of the surrounding healthy tissues. Two algorithms of iPlan BrainLAB treatment planning system were compared: Pencil Beam Convolution (PBC) and commercial Monte Carlo (iMC). Seven left-sided breast patients submitted to breast-conserving surgery were enrolled in the study. For each patient, four RT techniques – f-IMRT, IMRT using 2-fields and 5-fields (IMRT2 and IMRT5, respectively) and DCART – were applied. The dose distributions in the planned target volume (PTV) and the dose to the organs at risk (OAR) were compared analyzing dose–volume histograms; further statistical analysis was performed using IBM SPSS v20 software. For PBC, all techniques provided adequate coverage of the PTV. However, statistically significant dose differences were observed between the techniques, in the PTV, OAR and also in the pattern of dose distribution spreading into normal tissues. IMRT5 and DCART spread low doses into greater volumes of normal tissue, right breast, right lung and heart than tangential techniques. However, IMRT5 plans improved distributions for the PTV, exhibiting better conformity and homogeneity in target and reduced high dose percentages in ipsilateral OAR. DCART did not present advantages over any of the techniques investigated. Differences were also found comparing the calculation algorithms: PBC estimated higher doses for the PTV, ipsilateral lung and heart than the iMC algorithm predicted.

Clinical and functional aspects of work-related musculoskeletal disorders among active workers

OBJECTIVE: To evaluate musculoskeletal disorders among active industrial workers. METHODS: The study was carried out in São Carlos, Southeastern Brazil, in 2005. One hundred and thirty-four female workers were physically evaluated and answered questions about their physical symptoms, filled out a pain scale and gave responses in the Oswestry Disability Questionnaire, and the Work Ability Index questionnaire. The data were analyzed descriptively, and in correlation tests and through applying logistic regression. The outcome was evaluated in relation to the perceptions of pain, symptoms, physical assessment, ability to work and disability. RESULTS: Clinical evaluations and sick leave presented positive correlations with the subjective variables. The Work Ability Index presented a negative correlation with the physical disability index (r=-0.69). Symptoms reported at the time of the assessment presented a good correlation with the results from the pain scale and the clinical findings. Previous sick leave showed an association with disability (OR=1.13; 95% CI:1.08;1.18). CONCLUSION: Symptom reports and pain scales may be useful for assessing current conditions at the time of evaluating individuals with work-related musculoskeletal disorders, as they are easier to apply. In more severe cases of such injuries, clinical and functional evaluations and questionnaires such as those relating to ability to work and disability are preferable. Precise and specific evaluations of these disorders may contribute towards fairer legal and administrative decisions.

Relação entre a unidade de biofeedback de pressão, deslocamento do centro de pressão e atividade eletromiográfica durante o active straight leg raising em indivíduos com e sem dor lombo-pélvica.

Introdução: A unidade de biofeedback de pressão, em indivíduos com dor lombo-pélvica, é utilizada durante exercícios de estabilização segmentar, no entanto ainda carece de evidência científica. Objetivo: Determinar a relação entre a unidade de biofeedback de pressão (UBFP), o deslocamento do centro de pressão no sentido médio-lateral (COPml) e a atividade eletromiográfica abdominal durante o active straight leg raising (ASLR) em indivíduos com e sem dor lombo-pélvica, bem como identificar diferenças entre os grupos. Metodologia: Estudo transversal analítico em 18 estudantes universitários voluntários com dor lombo-pélvica crónica inespecífica (GCD) e em 20 sem dor (GSD). Durante o ASLR (desafio postural dinâmico) foram avaliadas as variações máxima e média da pressão (recorrendo à UBFP) e do deslocamento do COPml (através da plataforma de forças), bem como a atividade muscular abdominal, bilateralmente, com recurso à eletromiografia de superfície. Estatisticamente recorreu-se à correlação de Spearman e ao teste Mann-Whitney U, ambos com um nível de significância de 0,05. Resultados: No GCD, ao contrário do GSD, não foi verificada uma relação entre a UBFP e a atividade do transverso abdominal/obliquo interno (TrA/OI) contra-lateral. Correlações moderadas, mas com sentidos opostos, foram evidenciadas em ambos os grupos, entre o deslocamento do COPml e a atividade do TrA/OI contra-lateral. Em ambos os grupos, a UBFP demonstrou estar fortemente correlacionada com o COPml. Não foram observadas diferenças significativas entre os grupos nas variáveis avaliadas. Conclusão: A UBFP, no GCD, não se apresentou relacionada com a atividade do TrA/OI. Contudo, demonstrou uma relação com o deslocamento do COPml, em ambos os grupos, sendo portanto um indicador de estabilidade do tronco e assim, uma ferramenta útil em ambiente clínico. No GCD observou-se que uma maior atividade muscular TrA/OI pressupõe maior deslocamento do COPml, sendo uma relação contrária à verificada no GSD, podendo ser um indicador da perda da sua ação tónica.

Factors associated to quality of life in active elderly

OBJECTIVE: To analyze whether quality of life in active, healthy elderly individuals is influenced by functional status and sociodemographic characteristics, as well as psychological parameters. METHODS: Study conducted in a sample of 120 active elderly subjects recruited from two open universities of the third age in the cities of São Paulo and São José dos Campos (Southeastern Brazil) between May 2005 and April 2006. Quality of life was measured using the abbreviated Brazilian version of the World Health Organization Quality of Live (WHOQOL-bref) questionnaire. Sociodemographic, clinical and functional variables were measured through crossculturally validated assessments by the Mini Mental State Examination, Geriatric Depression Scale, Functional Reach, One-Leg Balance Test, Timed Up and Go Test, Six-Minute Walk Test, Human Activity Profile and a complementary questionnaire. Simple descriptive analyses, Pearson's correlation coefficient, Student's t-test for non-related samples, analyses of variance, linear regression analyses and variance inflation factor were performed. The significance level for all statistical tests was set at 0.05. RESULTS: Linear regression analysis showed an independent correlation without colinearity between depressive symptoms measured by the Geriatric Depression Scale and four domains of the WHOQOL-bref. Not having a conjugal life implied greater perception in the social domain; developing leisure activities and having an income over five minimum wages implied greater perception in the environment domain. CONCLUSIONS: Functional status had no influence on the Quality of Life variable in the analysis models in active elderly. In contrast, psychological factors, as assessed by the Geriatric Depression Scale, and sociodemographic characteristics, such as marital status, income and leisure activities, had an impact on quality of life.