Effect of Mirror Therapy on Post-Needling Pain Following Deep Dry Needling of Myofascial Trigger Point in Lateral Elbow Pain: Prospective Controlled Pilot Trial.

Background: This prospective randomized, controlled pilot trial to explore the immediate effect of adding Mirror Visual Feedback Therapy on pain sensitivity and motor performance among subjects suffering from post-needling pain diagnosed as Lateral Elbow Pain. Methods: A total of 49 participants (23 female, 26 male) were enrolled and randomly allocated to either the experimental group, which received Deep Dry Needling in the m. Brachioradialis, Ischemic Compression, Cold Spray, Stretching, and Mirror Visual Feedback Therapy (n = 25), or a control group without Mirror Visual Feedback Therapy (n = 24). Pre- and post-treatment evaluations included assessments of post-needling pain intensity, pressure pain threshold, two-point discrimination threshold, and maximum hand grip strength. Results: Intergroup analysis revealed a statistically significant reduction in post-needling pain intensity favoring the experimental group (U = 188.00, p = 0.034). Additionally, intragroup analysis showed significant improvements in post-needling pain intensity (MD = 0.400, SEM = 0.271, W = 137.00, p = 0.047) and pressure pain threshold (MD = 0.148 Kg/cm2, SEM = 0.038, W = 262.00, p < 0.001) within the experimental group following the intervention. Conclusions: These findings suggest a potential benefit of integrating Mirror Visual Feedback Therapy into treatment protocols for individuals with Lateral Elbow Pain experiencing post-needling discomfort. Further research is necessary to fully elucidate the clinical implications of these findings.

Percutaneous Electrical Nerve Stimulation (PENS) for Infrapatellar Saphenous Neuralgia Management in a Patient with Myasthenia gravis (MG).

Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness of the cranial and skeletal muscles, however, neuropathies are extremely rare. In this case report we present a case of a 61-year-old man diagnosed Myasthenia gravis who came to our attention due to a 1 week of acute deep pain [NPRS 8/10] in the anterior and medial right knee which occurred during walking [NPRS 8/10] or stair climbing [NPRS 9/10]. A complete medical record and clinical examination based on physical exploration and ultrasound assessment confirmed a infrapatellar saphenous neuralgia. Therapeutic interventions included Percutaneous nerve electrical stimulation combined with pain neuroscience education, neural mobilization of the saphenous nerve and quadriceps resistance exercises. After 4 weeks, pain intensity [NRPS = 1/10], knee functionality [OKS = 41/48] and lower limb functionality [LLFI = 80%] were notably improved, nevertheless, fatigue [RPE = 2/10] was similar than baseline. At 2 months of follow-up, the effect on intensity of pain NRPS [0/10] and functionality OKS [40/48] and LLFI [82%] was maintained, however, no significant clinical changes were detected on perceived fatigue RPE Scale [2/10]. Despite the important methodological limitations of this study, our case report highlights the efficacy of percutaneous electrical nerve stimulation combined with physical agents modalities for pain and functionality of infrapatellar saphenous neuralgia in the context of Myasthenia gravis.

Valorization of potato peels and eggshells wastes: Ca-biocomposite to remove and recover phosphorus from domestic wastewater.

Potato peel (PP) waste are generated in huge quantities, causing environmental pollution and health problems. Therefore, obtaining value-added products from PP is a current research challenge. In this work, novel Ca-biocomposites for phosphorus (P) removal were prepared by pyrolysis (500-800 °C) using eggshell (ES) and PP (ES/PP = 1:2 ratio by weight). ESPP-700 (pyrolyzed at 700 °C), reached a Qmax of 174.8 mg P/g, while the application of Ca-biocomposites in domestic wastewater showed 85.96% of P removal. According to the pseudo-second-order kinetic model, P adsorption was dominated by chemisorption, follows by apatite precipitation. The P solubility (62.5 wt.%) in formic acid (2.0 wt.%) and the water-soluble P (3.2 wt.%) for ESPP-700 after P adsorption, indicated that the final product would work as fertilizer for acidic soils. This is an important step in the management of agricultural wastes to implement the 3R slogan "Reduce, Reuse, Recycle" towards a circular economy.

Unraveling the Ca-P species produced over the time during phosphorus removal from aqueous solution using biocomposite of eggshell-palm mesocarp fiber.

Phosphorus (P) adsorption from aqueous solutions is usually evaluated by monitoring the P concentration and employed kinetic models. In this work, three adsorbents obtained from eggshell (ES) and eggshell mixed with palm mesocarp fiber (ESF-1:1 and ESF-1:10) at different Ca(OH)2/CaCO3 compositions were evaluated, and the Ca-P species formed monitored as a function of time deconvoluting Fourier Transform Infrared (FTIR) spectra. At 0.25 h the ESF-1:10 (Ca(OH)2: 26.2 wt%) exhibited better adsorption performance of 35 mgg-1 while ESF-1:1 and ES (Ca(OH)2: 2.8 and 3.0 wt%) showed 26 and 4 mgg-1, respectively. Characteristic PO43- bands in apatite were corroborated by XRD and FTIR. It was found that the role of Ca(OH)2 in the adsorption ends before 0.25 h, and thereafter CaCO3 becomes the phase responsible for the removal of orthophosphate H2PO4-/HPO42-/PO43- ions. The results indicate a direct ligand exchange of CO32- for PO43- that takes place while increasing the apatite crystallinity. On the other hand, the P adsorption process is also dependent on P concentration. At low P concentrations, characteristic bands of PO43- in apatite were observed in FTIR, while at high concentrations, characteristic bands for adsorbed HPO42- were obtained. The obtained results give a relevant role to CaCO3 in P adsorption. Kinetic analysis for Ca-based biocomposites showed that the Avrami order kinetic model fits better for the adsorbents. For P adsorption isotherm process the Langmuir's isotherms showed a good fit, with a maximum adsorption capacity of 90.8, 134.0, and 67.9 mgg-1 for ES, ESF-1:1, and ESF-1:10, respectively.

Association between hospital finances, payer mix, and complications after hyperthermic intraperitoneal chemotherapy: deficiencies in the current healthcare reimbursement system and future implications.

BACKGROUND: Despite increasing implementation of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), there are little data on its financial implications. We analyzed hospital cost and reimbursement data within the context of insurance provider type and postoperative complications. METHODS: Clinicopathologic variables, hospital costs, and reimbursement for all patients undergoing CRS/HIPEC at a single institution from 2009 to 2013 were analyzed. RESULTS: A total of 64 patients underwent CRS/HIPEC. Median PCI score was 19, and average operative time was 550 min. Tumor histology included appendiceal (n = 40; 62 %), colorectal (n = 16; 25 %), goblet cell (n = 5; 8 %), and mesothelioma (n = 3; 5 %). Median length-of-stay was 13 days. Complications occurred in 42 patients (66 %), including 13 (20 %) with major (Clavien grade III-IV) complications. Payer mix included 42 private insurance and 22 Medicare/Medicaid. Financial data was available for 56 patients: average total hospital cost was $49,248 and reimbursement was $63,771, for a hospital profit of $14,523/patient. Despite similar costs between Medicare/Medicaid and private-insurance patients, Medicare/Medicaid reimbursed much less ($30,713 vs $80,747; p < 0.001), resulting in a net loss of $17,342 per patient. For private-insured patients, major complications were associated with increased cost and increased reimbursement, resulting in a net profit of $36,285, compared with a net loss of $54,274 in Medicare/Medicaid patients. CONCLUSIONS: CRS/HIPEC is profitable in privately insured patients, even for those with major complications, but loses money in patients with Medicare/Medicaid. Under a future bundled-reimbursement system, complications will be negatively associated with profit. With these impending changes, hospitals must place emphasis on value, recalculate the reimbursement necessary for financial viability, and focus on decreasing costs and minimizing complications.

Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk?

OBJECTIVE: To investigate the course of health-related quality of life (HQL) over time in patients with peritoneal carcinomatosis (PC) after complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: Prospective, single-center, nonrandomized cohort study using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. RESULTS: Ninety patients who underwent CRS and HIPEC for PC in our institution were enrolled in the study. Mean age was 56 years (range 27-77 years) (61% female). Primary tumor was colorectal in 21%, ovarian in 19%, pseudomyxoma peritonei in 16%, an appendix tumor in 16%, gastric cancer in 10%, and peritoneal mesothelioma in 13% of cases. Mean peritoneal carcinomatosis index was 22 (range 2-39). Mean global health status score was 69±25 preoperatively and 55±20, 66±22, 66±23, 71±23, and 78±21 at months 1, 6, 12, 24, and 36, respectively. Physical and role function recovered significantly at 6 months and were close to baseline at the 24-month measurement. Emotional function starting from a low baseline recovered to baseline by month 12. Cognitive and social function had slow recovery on follow-up. Fatigue, diarrhea, dyspnea, and sleep disturbance were symptoms persistent at 6-month follow-up, improving later on in survivors. CONCLUSIONS: Survivors after CRS and HIPEC have postoperative quality of life similar to preoperatively, with most of the reduced elements recovering after 6-12 months. We conclude that reduced quality of life of patients after CRS and HIPEC should not be used as an argument to deny surgical therapy to these patients.

Solubility of amphotericin B in water-lecithin-dispersions and lecithin-based submicron emulsions.

The aim of this work was to evaluate water-lecithin-dispersions (WLDs) as carriers for amphotericin B (AmB) and to compare the drug solubility in WLDs and O/W lecithin-based submicron emulsions (SMEs) in order to evaluate the influence of lecithin content on the dosage form solubilization of the active compound. WLDs and different SMEs with either 1.2 or 2.4% of lecithin were prepared. WLD with 2.4% lecithin show a 10-fold increase in solubilization of AmB compared with 1.2% lecithin WLD. SMEs with 1.2% lecithin show an increase of over 400 times in solubilization compared with WLD containing the same concentration of lecithin, whereas SMEs with 2.4% lecithin show an increase of over 40 times compared with the corresponding WLD. Drug solubilization in SMEs with 2.4% lecithin is not significantly greater than in those containing 1.2% lecithin. The content of surfactant Brij 97 ® had a significant influence on drug solubilization in SMEs (P < 0.05). Results indicate that indicate that SMEs are proper systems to solubilize AmB. It can be assumed that solubilization is due to the formulation microstructure and not to the separate components themselves.