Effect of Seated Cervical Spinal Manipulation on Autonomic Nervous System Activity as Measured by Heart Rate Variability and Plasma Norepinephrine Levels: A randomized Pre- and Poststudy.

OBJECTIVE: The objective of this study was to determine whether seated cervical manipulation produced changes in autonomic nervous system activity, as measured by heart rate variability and plasma norepinephrine levels. METHODS: Ninety-five healthy young adults (ages 20-48 years) were recruited into a single-blinded physiological study, with 47 randomized to a seated cervical manipulation and 44 randomized to a sham procedure. Heart rate variability in the frequency domain, and plasma norepinephrine levels were measured prior to, immediately following, and 5 minutes following the intervention. RESULTS: Electrocardiograms were obtained from 39 subjects in the sham group and 43 subjects in the manipulation group. No statistically significant changes were found in measures of heart rate variability in the frequency domain in either the manipulation or sham groups. Blood samples were obtained from 22 subjects in the sham group and 27 subjects in the manipulation group. Plasma norepinephrine levels, as measured by spectrophotometry, declined in both groups from pre- to immediately postintervention, and they remained at decreased levels 5 minutes after the interventions. There were no statistically significant differences between groups in pre- or postintervention norepinephrine levels. CONCLUSIONS: Measures of heart rate variability and plasma norepinephrine levels did not show that seated cervical manipulation produced short-term changes in autonomic nervous system activity compared to a sham procedure in healthy young adults.

Discomfort, pain and stiffness: what do these terms mean to patients? A cross-sectional survey with lexical and qualitative analyses.

BACKGROUND: While pain is often the focus of clinical interventions, other clinical outcomes (e.g., discomfort, stiffness) might also contribute to patients' functionality and well-being. Although researchers and clinicians may view discomfort, pain and stiffness as different constructs, it remains unclear how patients perceive and differentiate between these constructs. Therefore, the purpose of this study was to explore patients' perceptions of pain, discomfort, and stiffness. METHODS: Chiropractic patients were invited to complete an online cross-sectional survey and describe what 'discomfort', 'pain' and 'stiffness' meant to them using their own words. Lexical and inductive qualitative content analyses were conducted independently and then triangulated. RESULTS: Fifty-three chiropractic patients (47.2% female, mean age: 39.1 ± 15.1 years) responded. The most common combinations of words to describe discomfort were "can be ignored" and "less severe than". "Cannot be ignored" and "sharp shooting" were used to describe pain. "Limited range of motion" was used to describe stiffness. Qualitatively, five themes were developed: impact, character, feeling, intensity and temporality. Stiffness was described as limited movement/mobility. Although discomfort and stiffness impacted patients' activities, patients remained functional; pain was described as stopping/limiting activities. Discomfort was described as dull and tingling, pain as sharp and shooting, and stiffness as tight and restricted. Patients felt displeased and annoyed when experiencing discomfort and stiffness but hurt and in danger of harm when experiencing pain. Discomfort and stiffness were described as less intense than pain, with shorter/intermittent duration; however, all constructs could be experienced constantly. CONCLUSION: Patients perceived discomfort, pain and stiffness as different, yet overlapping constructs. This preliminary work advances our knowledge of how patients conceptualize these constructs, contributing to better understanding of what patients mean when reporting these experiences, potentially improving the clinician-patient communication.

Mitigating Bias in the Measurement of Heart Rate Variability in Physiological Studies of Spinal Manipulation: A Comparison Between Authentic and Sham Manipulation.

OBJECTIVE: The purpose of this study was to identify sources and strategies for the mitigation of bias in studies of spinal manipulation and heart rate variability. METHODS: A small-scale study compared the effects of a single session of sham and authentic cervical manipulation on heart rate variability as measured by power spectrum analysis. The participants were a sample of 31 healthy young students from the Canadian Memorial Chiropractic College, randomized into 2 study arms. The effectiveness of blinding was evaluated, and 2 alternative methods of data analysis were explored to mitigate risk of bias. Following execution of the study, the stages of implementation and data processing were scored against version 2 of the Cochrane risk-of-bias tool for randomized trials for risk of bias. RESULTS: The risk of bias arising from (1) the randomization process, (2) missing outcome data, and (3) selection of reported results was judged to be low. Risk of bias in (1) deviations from intended interventions (particularly due to the failure of masking) and (2) the measurement of the outcome, for example, through cleaning of the data, were judged to be high. CONCLUSION: The use of power spectrum analysis of heart rate variability based on 5-minute recordings of echocardiogram pre-and post-intervention contained multiple sources of bias that were challenging to mitigate. Based upon these findings, power spectrum analysis of heart rate variability using these parameters may be ill-suited to the study of physiological effects of spinal manipulative therapy.

Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial.

OBJECTIVES: To compare the effectiveness of a comprehensive nonsurgical training program to a self-directed approach in improving walking ability in lumbar spinal stenosis (LSS). DESIGN: Randomized controlled trial. SETTING: Academic hospital outpatient clinic. PARTICIPANTS: Participants (N=104) with neurogenic claudication and imaging confirmed LSS were randomized. The mean age was 70.6 years, 57% were women, 84% had leg symptoms for >12 months, and the mean maximum walking capacity was 328.7 m. INTERVENTIONS: A 6-week structured comprehensive training program or a 6-week self-directed program. MAIN OUTCOME MEASURES: Continuous walking distance in meters measured by the Self-Paced Walk Test (SPWT) and proportion of participants achieving at least 30% improvement (minimally clinically important difference [MCID]) in the SPWT at 6 months. Secondary outcomes included the Zurich Claudication Questionnaire (ZCQ), Oswestry Disability Index (ODI), ODI walk score, and the Short-Form General Health Survey subscales. RESULTS: A total of 48 versus 51 participants who were randomized to comprehensive (n=51) or self-directed (n=53) treatment, respectively, received the intervention and 89% of the total study sample completed the study. At 6 months, the adjusted mean difference in walking distance from baseline was 421.0 m (95% confidence interval [95% CI], 181.4-660.6), favoring the comprehensive program and 82% of participants in the comprehensive group and 63% in the self-directed group achieved the MCID (adjusted relative risk, 1.3; 95% CI, 1.0-1.7; P=.03). Both primary treatment effects persisted at 12 months favoring the comprehensive program. At 6 months, the ODI walk score and at 12 months the ZCQ, Medical Outcomes Study 36-Item Short-Form Health Survey-physical function and -bodily pain scores showed greater improvements favoring the comprehensive program. CONCLUSIONS: A comprehensive conservative program demonstrated superior, large, and sustained improvements in walking ability and can be a safe nonsurgical treatment option for patients with neurogenic claudication due to LSS.

TENS-like Stimulation Downregulates Inflammatory Cytokines in a PC-12 Cell Line.

OBJECTIVES: The purpose of this study was to evaluate the effects of transcutaneous electrical nerve stimulation (TENS)-like stimulation on the expression of the proinflammatory cytokines tumor necrosis factor α (TNF-α), interleukin 1ß (IL-1ß), and IL-6 in PC-12 cells, which are commonly used as neuronal cell models. METHODS: Nerve growth factor-differentiated PC-12 cells were exposed to electrical stimulation for 15 minutes at 1 mA, 200 µs, and 100 Hz. Cell lysate from stimulated and control cells was assayed for TNF-α, IL-1ß, and IL-6. In 6 trials, cells were preincubated with the L-type ion channel blocker nicardipine. Cultured cells were also incubated with Alexa Fluor 488 and visualized by fluorescence microscopy to determine the nuclear vs cytoplasmic distribution of the p65 sub-unit of NF-κB RESULTS: Compared with control (unstimulated) cells, the stimulated cells had a downregulation of the assayed cytokines. However, preincubation with the L-type ion channel blocker nicardipine blocked this effect of stimulation. Additionally, it was noted that TENS-like stimulation promoted a relative sequestration of the p65 subunit of NF-κB in the cytoplasm vs the nucleus. CONCLUSIONS: It appears that in this cell line and with these stimulation parameters, TENS-like stimulation attenuated the expression of the assayed proinflammatory cytokines, in part by promoting the relative sequestration of the p65 subunit of NF-κB in the cytoplasm, and that voltage-dependent calcium channels have a role in the cascade of events initiated by the TENS-like stimulation.

Impact of hype on clinicians' evaluation of trials - a pilot study.

Objective: The purpose of this study was to determine the practicality of using a teleconferencing platform to assess the effect of hype on clinicians' evaluations of reports of clinical trials in spinal care. Methods: Twelve chiropractic clinicians were interviewed via a videoconferencing application. Interviews were recorded and timed. Participant behaviour was monitored for compliance with the protocol. Differences between participants numerical ratings of hyped and non-hyped abstracts based on four measures of quality were analysed using pairwise comparisons (Wilcoxon signed rank test for independent samples). In addition, a linear mixed effects model was fitted with condition (i.e. hype vs. no hype) as a fixed effect and participant and abstract as random effects. Results: The interviews and data analysis were conducted without significant technical difficulty. Participant compliance was high, and no harms were reported. There were no statistically significant differences in the quality rankings of hyped versus non-hyped abstracts. Conclusion: The use of a videoconferencing platform to measure the effects of hype on clinicians' evaluations of abstracts of clinical trials is practical and an adequately powered study is justified. Lack of statistically significant results may well be due to low participant numbers.

Objectif: L'objectif de cette étude était de déterminer s'il était possible d'utiliser une plateforme de téléconférence pour mesurer l'effet du battage médiatique sur les évaluations par les cliniciens des rapports d'essais cliniques dans le domaine des soins de la colonne vertébrale. Méthodes: Douze chiropracticiens ont été interrogés par le biais d'une application de vidéoconférence. Les entretiens ont été enregistrés et chronométrés. Le comportement des participants a été contrôlé pour s'assurer qu'ils respectaient le protocole. Les différences entre les évaluations numériques des participants pour les résumés avec et sans publicité, basées sur quatre mesures de qualité, ont été analysées en utilisant des comparaisons par paire (test de rang signé de Wilcoxon pour les échantillons indépendants). En outre, un modèle linéaire à effets mixtes a été ajusté avec la condition (c'est-à-dire avec ou sans battage publicitaire) comme effet fixe et le participant et le résumé comme effets aléatoires. Résultats: Les entretiens et l'analyse des données se sont déroulés sans difficulté technique majeure. Les participants se sont montrés très coopératifs et aucun problème n'a été signalé. Il n'y a pas eu de différences statistiquement significatives dans le classement de la qualité des résumés avec ou sans battage médiatique. Conclusion: L'utilisation d'une plate-forme de vidéoconférence pour mesurer les effets du battage médiatique sur les évaluations des résumés d'essais cliniques par les cliniciens est pratique et une étude suffisamment puissante est justifiée. L'absence de résultats statistiquement significatifs pourrait bien être due au faible nombre de participants.

Promotional Language (Hype) in Abstracts of Publications of National Institutes of Health-Funded Research, 1985-2020.

Importance: Investigators applying for National Institutes of Health (NIH) funding increasingly use promotional language (or hype) that has the potential to undermine objective evaluation. Whether or not the same investigators use hype in subsequent research reports has yet to be investigated. Objective: To assess changes in the use of hype in journal abstracts reporting research funded by the NIH and to compare those trends with previously reported trends in the associated NIH funding applications. Design, Setting, and Participants: This cross-sectional study assessed trends (from 1985 to 2020) in the use of promotional adjectives in abstracts of journal articles reporting NIH-funded research, and then compared those trends with previously reported trends for the associated NIH funding applications. Articles included in analyses had abstracts available in PubMed. Main Outcomes and Measures: Absolute change for the 139 adjective forms that have previously been identified as representing hype in NIH funding applications was measured as the difference in frequency between 1985 and 2020. Relative change was measured as the percentage change in frequency in 2020 relative to 1985, or the first year of occurrence. Consistency of change was measured by the rank order correlation (Kendall τ). Concordance between longitudinal trends in the journal abstracts and NIH funding applications was measured by the rank-order cross-correlation. Results: In a total of 2 394 480 journal abstracts, all 139 adjective forms were identified in 2 793 592 total occurrences. Among these adjectives, 133 increased in absolute frequency by 5335 words per million (wpm), with a mean (SD) relative increase of 1404% (2371%). The largest absolute increases were for novel (524 wpm), important (414 wpm), and key (378 wpm). The largest relative increases were for scalable (22 wpm [19 964%]), unmet (23 wpm [12 126%]), and tailored (40 wpm [8169%]). The mean (SD) correlation for all adjectives was 0.70 (0.30) with 95 adjectives showing a strong positive correlation (τ > 0.7; P < .001), 24 a moderate positive correlation (0.5 < τ < 0.7; P < .001), and 3 a moderate negative correlation (-0.5 < τ < -0.7; P < .001). The mean (SD) cross-correlation was 0.64 (0.19) with 61 of the 139 adjectives showing a strong positive cross-correlations (τ > 0.7; P < .001), 53 a moderate positive cross-correlations (0.5 < τ < 0.7; P < .001), and 3 a moderate negative cross-correlation (-0.7 < τ < -0.5; P < .001). Conclusions and Relevance: In this analysis of journal abstracts reporting NIH-funded research from 1985 to 2020, levels of promotional language were found to be increasing and trends were closely associated with previously reported trends in the related NIH funding applications. This suggests that increasing levels of salesmanship may in part be a downstream effect of salesmanship infused during earlier stages of the research cascade.

Trends in the Use of Promotional Language (Hype) in Abstracts of Successful National Institutes of Health Grant Applications, 1985-2020.

Importance: The integrity of the grant application process is important to the success of the entire research enterprise. However, little information is available concerning the prevalence and evolution of subjective or promotional language ("hype") that has the potential to undermine objectivity in the writing and evaluation of grant applications. Objective: To assess changes over time in the use of hype in abstracts of National Institutes of Health (NIH) grant applications. Design, Setting, and Participants: This cross-sectional study assessed the prevalence of promotional adjectives in abstracts in the NIH archive from 1985 to 2020. Main Outcomes and Measures: From all abstracts in the NIH RePORTER (Research Portfolio Online Reporting Tools: Expenditures and Results) archive, adjectives were automatically extracted, and their frequencies in the most recent year (2020) were assessed relative to the start year (1985). Adjectives that shifted significantly in frequency and that carried a promotional sense (ie, hype) were retained, and patterns of change were assessed by plotting yearly frequencies (1985-2020). By grouping the adjectives based on shared semantic properties, broad meanings commonly expressed by hype were identified. Absolute change was measured as the difference in normalized frequency between 1985 and 2020. Relative change was measured as the percentage change in normalized frequency in 2020 relative to 1985, or the first year of occurrence. Results: In total, 901 717 abstracts were analyzed and 139 adjective forms were identified as hype. Among these 139 adjective forms, 130 hype adjectives increased in frequency by 7690 words per million (wpm) (mean [SD] relative increase, 1378% [3132%]), while 9 hype adjectives decreased in frequency by 686 wpm (mean [SD] relative decrease, 44% [18%]). The largest absolute increases were for the terms novel (1054 wpm), critical (555 wpm), and key (461 wpm), while the largest relative increases were for the terms sustainable (25 157%), actionable (16 114%), and scalable (13 029%). Hype most often serves to promote the significance, novelty, scale, and rigor of a project; the utility of the expected outcomes; the qualities of the investigators and research environment; and the gravity of the problem; as well as conveying the personal attitudes of the applicants. Conclusions and Relevance: Levels of hype in successful NIH grant applications have increased over time from 1985 to 2020. The findings in this study should serve to sensitize applicants, reviewers, and funding agencies to the increasing prevalence of subjective, promotional language in funding applications.

The research enterprise at Canadian Memorial Chiropractic College.

OBJECTIVES: A bibliometric survey was conducted, using network and textual analysis tools, to assess the current state of the research enterprise at Canadian Memorial Chiropractic College and to augment planning processes. METHODS: Searches were conducted via several databases to identify publications attributable to the institution. Bibliometric data were summarized and post-processed using the programme VosViewer and analysis tools provided in the Web of Science. RESULTS: Canadian Memorial Chiropractic College is a productive source of peer-reviewed publications supported by a diverse suite of funding agencies and collaborating institutions, and published across a broad range of journals. CONCLUSIONS: As a private, single-purpose educational institution, awarding a qualification only in chiropractic, Canadian Memorial Chiropractic College probably performs well in its class of institution in terms of research productivity. However, assessment is constrained by inconsistencies on the part of authors, journals and databases in archiving data.

OBJECTIFS: On a mené une enquête bibliométrique à l'aide d'outils d'analyse de réseau et d'analyse textuelle, pour évaluer l'effort de recherche actuel du Canadian Memorial Chiropractic College et améliorer les processus de planification. MÉTHODES: On a interrogé plusieurs bases de données pour trouver des articles publiés par le College. Les données bibliométriques ont été résumées et post-traitées à l'aide du programme VosViewer et des outils d'analyse fournis dans le Web of Science. RÉSULTATS: Le Canadian Memorial Chiropractic College est une source abondante de parutions évaluées par des pairs, soutenues par un ensemble diversifié d'organismes de financement et d'établissements collaborateurs, et publiées dans un large éventail de revues. CONCLUSIONS: À titre d'établissement d'enseignement privé à vocation unique, qui ne délivre qu'une seule attestation de compétence en chiropratique, le Canadian Memorial Chiropractic College fait probablement bonne figure dans sa catégorie d'établissements pour ce qui est de la productivité en recherche. Toutefois, l'évaluation est limitée par certaines incohérences entre les données archivées par les auteurs, les revues et les bases de données.

Cerebrospinal fluid pressure response to upper cervical vertebral motion and displacement in the anesthetized rat.

OBJECTIVE: This study examined whether aligned or off-axis (subluxated) static and dynamic vertebral displacement within normal physiological ranges modulated cerebrospinal fluid pressure (CSF) as is considered to occur by some chiropractic theories. METHODS: Cerebrospinal fluid pressure pressure was measured via a subarachnoid catheter implanted at the lumbar level in 12 anesthetized adult male Wistar rats. A computer-driven manipulator was used to impose 3 motion patterns on the C2 vertebra: (i) dynamic oscillatory displacement (24 degrees peak-to-peak 1.0 and 2.0 Hz), (ii) static rotary (ramp 20 degrees at 10 degrees per second and hold for 4 minutes) displacement about both the normal and an offset axis of rotation, and (iii) a spinal manipulative thrust displacement (200 degrees per second; 12 degrees peak-to-peak). RESULTS: The CSF pressure at rest for all rats ranged from 4.5 to 9.1 mm Hg, with a mean (+/- SD) of 6.3 +/- 1.4 mm Hg. Of the imposed movements, only an offset ramp and hold displacement resulted in a significant (P < .05) difference between the CSF pressure before (6.1 +/- 0.7 mm Hg) and during the imposed movement (6.6 +/- 0.7 mm Hg). None of the interventions were associated with significant changes in the powers of the principal peaks of the CSF pressure power spectrum. CONCLUSIONS: The results of this study suggest that static or dynamic displacement of an upper cervical vertebra within the limits of tissue integrity do not induce physiologically important changes in absolute CSF pressure or pressure dynamics in anesthetized rats.

Presumptive spondylogenic pruritus: a case study.

OBJECTIVE: To describe a case of a patient with chronic pruritus of the upper back and arms who underwent complete resolution of his complaint following a short course of chiropractic care. CASE PRESENTATION: A 36-year-old male suffering with chronic, severe pruritus affecting the upper back and both arms, presented for chiropractic treatment after pharmacological treatment and dietary restrictions failed to resolve his complaint. Physical examination revealed restrictions of thoracic and cervical intervertebral motion. However, radiological examination did not identify any substantial pathology of the spine. Following a short course of chiropractic treatment, which included spinal manipulation and home exercises, his complaint of pruritus resolved completely. SUMMARY: In this case, a severe and chronic complaint of pruritus which was refractory to other forms of care resolved quickly after the institution of chiropractic care. It is therefore hypothesized that the patient's pruritus was etiologically linked to biomechanical problems of the spine.

OBJECTIF: Décrire le cas d'un patient présentant un prurit chronique à la partie supérieure du haut du dos et aux bras qui est complètement disparu après une courte période de traitements chiropratiques. EXPOSÉ DU CAS: Un homme de 36 ans souffrant d'un prurit chronique grave à la partie supérieure du dos et aux deux bras s'est présenté à une clinique chiropratique après avoir suivi un traitement pharmacologique et un régime alimentaire qui se sont avérés infructueux. L'examen physique a révélé une limitation de la mobilité articulaire de la colonne dorsale et de la colonne cervicale. L'examen radiologique n'a révélé aucune pathologie grave de la colonne vertébrale. Après une brève période de séances chiropratiques par manipulations vertébrales et un programme d'exercices à domicile, le prurit est complètement disparu. RÉSUMÉ: Dans ce cas, un prurit grave et chronique, réfractaire à d'autres formes de traitement, est disparu rapidement après le commencement des traitements chiropratiques. On peut donc supposer que le prurit du patient était lié à des troubles biomécaniques de la colonne vertébrale.

The passive voice and comprehensibility of biomedical texts: An experimental study with 2 cohorts of chiropractic students.

OBJECTIVE:: Authors in the health sciences are encouraged to write in the active voice in the belief that this enhances comprehensibility. Hence, the purpose of this study was to compare objectively measured and subjectively perceived comprehensibility of texts in which one voice or the other was highly prevalent. METHODS:: Objectively rated comprehensibility was obtained by presenting 161 2nd-year chiropractic students with questions pertaining to 2 methods sections of biomedical articles, each presented in its original form with high prevalence of the passive voice, and in a manipulated form with all main verbs in the active voice. The difficulties and sensitivities of questions were compared for the 2 forms of each text. Comprehensibility was obtained by asking students to rate the comprehensibility of authentic sentences from biomedical manuscripts and matched manipulated form in which the voice of the main verb had been changed. Differences in comprehensibility between the 2 texts were assessed with a dependent t test. RESULTS:: There were no significant differences in the difficulties or sensitivities of questions pertaining to the 2 original texts written in the passive voice versus the active voice ( p > .35 for all comparisons). Students rated sentences written in the passive voice as marginally more comprehensible than sentences written in the active voice ( p = .003 per 2-tailed paired t test). CONCLUSION:: The texts written in the active voice were not more comprehensible than texts written in the passive voice. The results of this study do not support editorial guidelines that favor active voice over passive voice.

Effect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trial.

Background context: Lumbar spinal stenosis (LSS) leads to diminished blood flow to the spinal nerves causing neurogenic claudication and impaired walking ability. Animal studies have demonstrated increased blood flow to the spinal nerves and spinal cord with superficial para-spinal electrical stimulation of the skin. Purpose: The aim of this study was to assess the effectiveness of active para-spinal transcutaneous electrical nerve stimulation (TENS) compared to de-tuned TENS applied while walking, on improving walking ability in LSS. Study design: This was a two-arm double-blinded (participant and assessor) randomized controlled trial. Patient sample: We recruited 104 participants 50 years of age or older with neurogenic claudication, imaging confirmed LSS and limited walking ability. Outcome measures: The primary measure was walking distance measured by the self-paced walking test (SPWT) and the primary outcome was the difference in proportions among participants in both groups who achieved at least a 30% improvement in walking distance from baseline using relative risk with 95% confidence intervals. Methods: The active TENS group (n = 49) received para-spinal TENS from L3-S1 at a frequency of 65-100 Hz modulated over 3-s intervals with a pulse width of 100-200 usec, and turned on 2 min before the start and maintained during the SPWT. The de-tuned TENS group (n = 51) received similarly applied TENS for 30 s followed by ramping down to zero stimulus and turned off before the start and during the SPWT.Study funded by The Arthritis Society ($365,000 CAN) and salary support for Carlo Ammendolia funded by the Canadian Chiropractic Research Foundation ($500,000 CAN over 5 years). Results: From August 2014 to January 2016 a total of 640 potential participants were screened for eligibility; 106 were eligible and 104 were randomly allocated to active TENS or de-tuned TENS. Both groups showed significant improvement in walking distance but there was no significant difference between groups. The mean difference between active and de-tuned TENS groups was 46.9 m; 95% CI (- 118.4 to 212.1); P = 0.57. A total of 71% (35/49) of active TENS and 74% (38/51) of de-tuned TENS participants achieved at least 30% improvement in walking distance; relative risk (RR), 0.96; 95% CI, (0.7 to 1.2) P = 0.77. Conclusions: Active TENS applied while walking is no better than de-tuned TENS for improving walking ability in patients with degenerative LSS and therefore should not be a recommended treatment in clinical practice. Registration: ClinicalTrials.gov ID: NCT02592642. Registration October 30, 2015.

A scoping review of chiropractic management of female patients with infertility.

BACKGROUND: Debate concerning chiropractic management of female infertility occurs largely in the absence of reference to the extant literature. METHODS: A scoping review was conducted of primary (original) data publications on the chiropractic management of female infertility based on searches of the Index to Chiropractic Literature and Pubmed, supplemented by papers from one author's archive. RESULTS: Ten articles, all case studies, met the review's inclusion criteria and documented the experiences of 11 women (mean age 31 years; mean period of infertility 3 years). Pregnancy occurred, on average, after 5 months of treatment with spinal manipulation and adjunctive modalities. No adverse events were reported. DISCUSSION: There are very few original data articles documenting responses of infertile females treated with spinal manipulation. CONCLUSIONS: In the absence of a robust body of primary data literature, the use of spinal manipulation the management of female infertility should be approached with caution.

CONTEXTE: Les controverses au sujet de la prise en charge chiropratique de l'infertilité féminine sont en grande partie liées à l'absence de référence à la littérature existante. MÉTHODOLOGIE: On a effectué une revue exploratoire de publications de données primaires (d'origine) sur la prise en charge chiropratique de l'infertilité féminine en consultant l'Index to Chiropractic Literature, Pubmed et divers documents provenant des archives d'un auteur. RÉSULTATS: Dix articles, qui étaient tous les études de cas, satisfaisaient les critères d'inclusion de la revue. Ils visaient à documenter l'expérience vécue par 11 femmes (âge moyen: 31 ans; durée moyenne de l'infertilité: 3 ans). En moyenne, ces femmes sont devenues enceintes au bout de 5 mois de traitement par manipulations vertébrales et des modalités d'appoint. Aucun effet défavorable n'a été signalé. DISCUSSION: Il existe très peu d'articles documentant les réponses de femmes infertiles traitées par manipulations vertébrales. CONCLUSIONS: En l'absence de corpus robuste de littérature sur des données primaires, il conviendrait de faire preuve de prudence en ayant recours aux manipulations vertébrales dans la prise en charge de l'infertilité féminine.

Contribution of supraspinal and spinal structures to the responses of dorsal spinal cord blood flow to innocuous cutaneous brushing in rats.

Responses of dorsal spinal cord blood flow (SCBF) to innocuous mechanical cutaneous stimulation were investigated in anesthetized central nervous system intact (CNS-intact) and C2 spinalized rats. SCBF was recorded at the L4-L6 level with a laser Doppler flowmeter. SCBF increased with brushing of the ipsilateral proximal hindlimb and hindpaw, and there were no significant differences in the magnitudes of the responses in CNS-intact and spinalized animals. Brushing of the lower back had no effect on SCBF at the L4-L6 level in either cohort. Brushing stimulation produced no significant changes in systemic arterial blood pressure. The responses of SCBF to brushing in CNS-intact animals were diminished by pretreatment with phenoxybenzamine, an alpha-adrenoceptor blocking agent, but no such effects were seen in spinalized animals. These results indicate that innocuous mechanical cutaneous input can produce a segmentally-organized increase in regional SCBF, and that the responses are modulated, in part at least, by alpha-adrenergic receptors via supraspinal structures.

Cerebrospinal fluid pressure in the anesthetized rat.

OBJECTIVE: The primary aims of this study were to determine the major frequencies and powers of oscillations in cerebrospinal fluid (CSF) pressure in the anesthetized rat, and determine whether the CSF pressure oscillations correlated with the major oscillation frequencies in the cardiovascular and respiratory systems as proposed by some chiropractic theories. METHODS: The cardiac and ventilatory cycles, and CSF pressure were simultaneously recorded during spontaneous and positive-pressure mechanical ventilation in the anesthetized rat. Power spectra were generated from the raw data to identify the major oscillation frequencies in cardiorespiratory and CSF data sets. Entrainment of CSF pressure with ventilation was tested by mechanically pacing the ventilation over a range of frequencies. RESULTS: The most powerful oscillation in CSF pressure was coincident with ventilatory chest movement during both spontaneous and mechanically paced ventilation. In 22 of 26 trials, there was also a very weak oscillation in CSF pressure that was entrained to heart rate. In addition, in 21 of 26 trials, it was possible to identify a low-frequency oscillation (<0.25 Hz) in CSF pressure that was coincident with a low-frequency oscillation in the power spectrum of the cardiac cycle. CONCLUSIONS: This study suggests oscillations in CSF pressure in the anesthetized rat are entrained to and driven by ventilation. The arterial pulse pressure makes little contribution to oscillations in CSF pressure in the immobile, anesthetized rat. This study provides normative, quantitative data on which to develop studies concerning the effects of vertebral movements and spinal posture on CSF dynamics.

Trends in the Use of Promotional Language (Hype) in National Institutes of Health Funding Opportunity Announcements, 1992-2020.

This cross-sectional study examines changes from 1992 to 2020 in the use of promotional language in National Institutes of Health (NIH) funding opportunity announcements in comparison with trends reported in NIH grant applications.

Responses of dorsal spinal cord blood flow to innocuous cutaneous stimulation in anesthetized rats.

In urethane-anesthetized, artificially-ventilated rats, alterations in dorsal spinal cord blood flow (SCBF) were measured with a laser Doppler flowmeter in response to innocuous mechanical cutaneous stimulation. SCBF recorded at the T12-L1 level increased with brushing of the ipsilateral, but not contralateral, upper back, lower back or proximal hindlimb. Brushing of the forepaw, proximal forelimb or hindpaw had no effect on T12-L1 SCBF. SCBF recorded at the L4-6 level increased with brushing of the ipsilateral, but not contralateral, proximal hindlimb and hindpaw. Brushing of the forepaw, proximal forelimb, upper back or lower back had no effect on SCBF at the L4-6 level. None of these brushing stimuli produced significant changes in systemic arterial blood pressure or heart rate. Pretreatment with phenoxybenzamine, an alpha adrenoceptor blocking agent, resulted in a small but statistically significant attenuation in the response of SCBF to brushing. However, pretreatment with propranolol, a beta adrenoceptor blocking agent, or atropine, a muscarinic cholinergic receptor blocking agent, produced no such effect. These results indicate that innocuous mechanical cutaneous input can produce a segmentally-organized increase in regional SCBF, which may be mediated in part, by alpha adrenergic receptors.

Spinal manipulation and spinal mobilization influence different axial sensory beds.

Manipulation and mobilization are two forms of manual therapy commonly employed in the management of musculoskeletal disorders. Spinal manipulation and mobilization are often distinguished from one another by reference to certain biomechanical parameters such as peak force, duration and magnitude of translation. However, as of yet, there is relatively little research which distinguishes between them in terms of neurological mechanisms or clinical effectiveness. Theories concerning the mechanisms underlying the therapeutic effects of manipulation and mobilization commonly make reference to mechanical events such as the release of entrapped tissue or the disruption of intra-articular adhesions. Relatively less attention is given to neural effects. In this paper, we hypothesize that, at least in part, spinal manipulation preferentially influences a sensory bed which, in terms of anatomical location and function, is different from the sensory bed influenced by spinal mobilization techniques. More specifically, we hypothesize that manipulation may particularly stimulate receptors within deep intervertebral muscles, while mobilization techniques most likely affect more superficial axial muscles. In part, our rationale for this hypothesis is based on differences in mechanical advantage of the respective manual procedures on multi-segmental versus short intervertebral muscles.