-
Annals of the New York Academy of... Apr 2022Laryngopharyngeal reflux (LPR) is a syndrome caused by reflux of gastric contents into the pharynx or larynx, which leads to symptoms of throat clearing, hoarseness,... (Review)
Review
Laryngopharyngeal reflux (LPR) is a syndrome caused by reflux of gastric contents into the pharynx or larynx, which leads to symptoms of throat clearing, hoarseness, pain, globus sensation, cough, excess mucus production in the throat, and dysphonia. LPR is a challenging condition, as there is currently no gold standard for diagnosis or treatment, and thus this presents a burden to the healthcare system. Strategies for treatment of LPR are numerous. Medical therapies include proton pump inhibitors, which are first line, H2 receptor antagonists, alginates, and baclofen. Other noninvasive treatment options include lifestyle therapy and the external upper esophageal sphincter compression device. Endoscopic and surgical options include antireflux surgery, magnetic sphincter augmentation, and transoral incisionless fundoplication. Functional laryngeal disorders and laryngeal hypersensitivity can present as LPR symptoms with or without gastroesophageal reflux disease. Though there are minimal studies in this area, neuromodulators and behavioral interventions are potential treatment options. Given the complexity of these patients and numerous available treatment options, we propose a treatment algorithm to help clinicians diagnose and triage patients into an appropriate therapy.
Topics: Humans; Laryngopharyngeal Reflux; Larynx; Proton Pump Inhibitors
PubMed: 34921412
DOI: 10.1111/nyas.14728 -
The Cochrane Database of Systematic... May 2015More than one in five patients who undergo treatment for breast cancer will develop breast cancer-related lymphedema (BCRL). BCRL can occur as a result of breast cancer... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
More than one in five patients who undergo treatment for breast cancer will develop breast cancer-related lymphedema (BCRL). BCRL can occur as a result of breast cancer surgery and/or radiation therapy. BCRL can negatively impact comfort, function, and quality of life (QoL). Manual lymphatic drainage (MLD), a type of hands-on therapy, is frequently used for BCRL and often as part of complex decongestive therapy (CDT). CDT is a fourfold conservative treatment which includes MLD, compression therapy (consisting of compression bandages, compression sleeves, or other types of compression garments), skin care, and lymph-reducing exercises (LREs). Phase 1 of CDT is to reduce swelling; Phase 2 is to maintain the reduced swelling.
OBJECTIVES
To assess the efficacy and safety of MLD in treating BCRL.
SEARCH METHODS
We searched Medline, EMBASE, CENTRAL, WHO ICTRP (World Health Organization's International Clinical Trial Registry Platform), and Cochrane Breast Cancer Group's Specialised Register from root to 24 May 2013. No language restrictions were applied.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) or quasi-RCTs of women with BCRL. The intervention was MLD. The primary outcomes were (1) volumetric changes, (2) adverse events. Secondary outcomes were (1) function, (2) subjective sensations, (3) QoL, (4) cost of care.
DATA COLLECTION AND ANALYSIS
We collected data on three volumetric outcomes. (1) LE (lymphedema) volume was defined as the amount of excess fluid left in the arm after treatment, calculated as volume in mL of affected arm post-treatment minus unaffected arm post-treatment. (2) Volume reduction was defined as the amount of fluid reduction in mL from before to after treatment calculated as the pretreatment LE volume of the affected arm minus the post-treatment LE volume of the affected arm. (3) Per cent reduction was defined as the proportion of fluid reduced relative to the baseline excess volume, calculated as volume reduction divided by baseline LE volume multiplied by 100. We entered trial data into Review Manger 5.2 (RevMan), pooled data using a fixed-effect model, and analyzed continuous data as mean differences (MDs) with 95% confidence intervals (CIs). We also explored subgroups to determine whether mild BCRL compared to moderate or severe BCRL, and BCRL less than a year compared to more than a year was associated with a better response to MLD.
MAIN RESULTS
Six trials were included. Based on similar designs, trials clustered in three categories.(1) MLD + standard physiotherapy versus standard physiotherapy (one trial) showed significant improvements in both groups from baseline but no significant between-groups differences for per cent reduction.(2) MLD + compression bandaging versus compression bandaging (two trials) showed significant per cent reductions of 30% to 38.6% for compression bandaging alone, and an additional 7.11% reduction for MLD (MD 7.11%, 95% CI 1.75% to 12.47%; two RCTs; 83 participants). Volume reduction was borderline significant (P = 0.06). LE volume was not significant. Subgroup analyses was significant showing that participants with mild-to-moderate BCRL were better responders to MLD than were moderate-to-severe participants.(3) MLD + compression therapy versus nonMLD treatment + compression therapy (three trials) were too varied to pool. One of the trials compared compression sleeve plus MLD to compression sleeve plus pneumatic pump. Volume reduction was statistically significant favoring MLD (MD 47.00 mL, 95% CI 15.25 mL to 78.75 mL; 1 RCT; 24 participants), per cent reduction was borderline significant (P=0.07), and LE volume was not significant. A second trial compared compression sleeve plus MLD to compression sleeve plus self-administered simple lymphatic drainage (SLD), and was significant for MLD for LE volume (MD -230.00 mL, 95% CI -450.84 mL to -9.16 mL; 1 RCT; 31 participants) but not for volume reduction or per cent reduction. A third trial of MLD + compression bandaging versus SLD + compression bandaging was not significant (P = 0.10) for per cent reduction, the only outcome measured (MD 11.80%, 95% CI -2.47% to 26.07%, 28 participants).MLD was well tolerated and safe in all trials.Two trials measured function as range of motion with conflicting results. One trial reported significant within-groups gains for both groups, but no between-groups differences. The other trial reported there were no significant within-groups gains and did not report between-groups results. One trial measured strength and reported no significant changes in either group.Two trials measured QoL, but results were not usable because one trial did not report any results, and the other trial did not report between-groups results.Four trials measured sensations such as pain and heaviness. Overall, the sensations were significantly reduced in both groups over baseline, but with no between-groups differences. No trials reported cost of care.Trials were small ranging from 24 to 45 participants. Most trials appeared to randomize participants adequately. However, in four trials the person measuring the swelling knew what treatment the participants were receiving, and this could have biased results.
AUTHORS' CONCLUSIONS
MLD is safe and may offer additional benefit to compression bandaging for swelling reduction. Compared to individuals with moderate-to-severe BCRL, those with mild-to-moderate BCRL may be the ones who benefit from adding MLD to an intensive course of treatment with compression bandaging. This finding, however, needs to be confirmed by randomized data.In trials where MLD and sleeve were compared with a nonMLD treatment and sleeve, volumetric outcomes were inconsistent within the same trial. Research is needed to identify the most clinically meaningful volumetric measurement, to incorporate newer technologies in LE assessment, and to assess other clinically relevant outcomes such as fibrotic tissue formation.Findings were contradictory for function (range of motion), and inconclusive for quality of life.For symptoms such as pain and heaviness, 60% to 80% of participants reported feeling better regardless of which treatment they received.One-year follow-up suggests that once swelling had been reduced, participants were likely to keep their swelling down if they continued to use a custom-made sleeve.
Topics: Bandages; Breast Neoplasms; Drainage; Female; Humans; Lymphedema; Massage; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 25994425
DOI: 10.1002/14651858.CD003475.pub2 -
Journal of Sport Rehabilitation Jan 2021Clinical Scenario: Endurance sports require a great deal of physical training to perform well. Endurance training and racing stress the skeletal muscle, resulting in... (Review)
Review
Clinical Scenario: Endurance sports require a great deal of physical training to perform well. Endurance training and racing stress the skeletal muscle, resulting in exercise-induced muscle damage (EIMD). Athletes attempt to aid their recovery in various ways, one of which is through compression. Dynamic compression consists of intermittent pneumatic compression (IPC) devices, such as the NormaTec Recovery System and Recovery Pump. Clinical Question: What are the effects of IPC on the reduction of EIMD in endurance athletes following prolonged exercise? Summary of Key Findings: The current literature was searched to identify the effects of IPC, and 3 studies were selected: 2 randomized controlled trials and 1 randomized cross-over study. Two studies investigated the effect of IPC on delayed onset muscle soreness and plasma creatine kinase in ultramarathoners. The other looked at the impact of IPC on delayed onset muscle soreness in marathoners, ultramarathoners, triathletes, and cyclists. All studies concluded IPC was not an effective means of improving the reduction of EIMD in endurance-trained athletes. Clinical Bottom Line: While IPC may provide short-term relief of delayed onset muscle soreness, this device does not provide continued relief from EIMD. Strength of Recommendation: In accordance with the Strength of Recommendation Taxonomy, the grade of B is recommended based on consistent evidence from 2 high-quality randomized controlled trials and 1 randomized cross-over study.
Topics: Creatine Kinase; Humans; Intermittent Pneumatic Compression Devices; Muscle Fatigue; Myalgia; Physical Endurance; Randomized Controlled Trials as Topic; Running
PubMed: 33418535
DOI: 10.1123/jsr.2020-0364 -
Seminars in Plastic Surgery Feb 2018Complex decongestive therapy is the mainstay of lymphedema (LE) therapy. It consists of two phases: an intensive volume reduction phase, principally involving... (Review)
Review
Complex decongestive therapy is the mainstay of lymphedema (LE) therapy. It consists of two phases: an intensive volume reduction phase, principally involving low-stretch bandages and manual lymph drainage (MLD), followed by compression garment use to maintain the reduction achieved. Adjunctive treatments include the use of a sequential gradient pump, LE-specific exercises, skin and nail care, as well as risk-reduction precautions. Herein the techniques are described and the evidence for their effectiveness is reviewed.
PubMed: 29636649
DOI: 10.1055/s-0038-1635119 -
Annual Review of Biomedical Engineering Jun 2022The treatment of end-stage heart failure has evolved substantially with advances in medical treatment, cardiac transplantation, and mechanical circulatory support (MCS)... (Review)
Review
The treatment of end-stage heart failure has evolved substantially with advances in medical treatment, cardiac transplantation, and mechanical circulatory support (MCS) devices such as left ventricular assist devices and total artificial hearts. However, current MCS devices are inherently blood contacting and can lead to potential complications including pump thrombosis, hemorrhage, stroke, and hemolysis. Attempts to address these issues and avoid blood contact led to the concept of compressing the failing heart from the epicardial surface and the design of direct cardiac compression (DCC) devices. We review the fundamental concepts related to DCC, present the foundational devices and recent devices in the research and commercialization stages, and discuss the milestones required for clinical translation and adoption of this technology.
Topics: Biomechanical Phenomena; Heart; Heart Failure; Heart, Artificial; Heart-Assist Devices; Humans
PubMed: 35395165
DOI: 10.1146/annurev-bioeng-110220-025309 -
Membranes Feb 2021In this paper an overview of commercial hydrogen separation technologies is given. These technologies are discussed and compared-with a detailed discussion on... (Review)
Review
In this paper an overview of commercial hydrogen separation technologies is given. These technologies are discussed and compared-with a detailed discussion on membrane-based technologies. An emerging and promising novel hydrogen separation technology, namely, electrochemical hydrogen separation (EHS) is reviewed in detail. EHS has many advantages over conventional separation systems (e.g., it is not energy intensive, it is environmentally-friendly with near-zero pollutants, it is known for its silent operation, and, the greatest advantage, simultaneous compression and purification can be achieved in a one-step operation). Therefore, the focus of this review is to survey open literature and research conducted to date on EHS. Current technological advances in the field of EHS that have been made are highlighted. In the conclusion, literature gaps and aspects of electrochemical hydrogen separation, that require further research, are also highlighted. Currently, the cost factor, lack of adequate understanding of the degradation mechanisms related to this technology, and the fact that certain aspects of this technology are as yet unexplored (e.g., simultaneous hydrogen separation and compression) all hinder its widespread application. In future research, some attention could be given to the aforementioned factors and emerging technologies, such as ceramic proton conductors and solid acids.
PubMed: 33668552
DOI: 10.3390/membranes11020127 -
Micromachines Oct 2019Recent advances in integrating microengineering and tissue engineering have enabled the creation of promising microengineered physiological models, known as... (Review)
Review
Recent advances in integrating microengineering and tissue engineering have enabled the creation of promising microengineered physiological models, known as organ-on-a-chip (OOC), for experimental medicine and pharmaceutical research. OOCs have been used to recapitulate the physiologically critical features of specific human tissues and organs and their interactions. Application of chemical and mechanical stimuli is critical for tissue development and behavior, and they were also applied to OOC systems. Mechanical stimuli applied to tissues and organs are quite complex in vivo, which have not adequately recapitulated in OOCs. Due to the recent advancement of microengineering, more complicated and physiologically relevant mechanical stimuli are being introduced to OOC systems, and this is the right time to assess the published literature on this topic, especially focusing on the technical details of device design and equipment used. We first discuss the different types of mechanical stimuli applied to OOC systems: shear flow, compression, and stretch/strain. This is followed by the examples of mechanical stimuli-incorporated OOC systems. Finally, we discuss the potential OOC systems where various types of mechanical stimuli can be applied to a single OOC device, as a better, physiologically relevant recapitulation model, towards studying and evaluating experimental medicine, human disease modeling, drug development, and toxicology.
PubMed: 31615136
DOI: 10.3390/mi10100700 -
HardwareX Dec 2023A low-cost ($120 NZD, $75 USD), low-power (1-year battery life), portable, and programmable syringe pump design is presented, which offers an alternative to high-cost...
A low-cost ($120 NZD, $75 USD), low-power (1-year battery life), portable, and programmable syringe pump design is presented, which offers an alternative to high-cost commercial devices with limited battery life. Contrary to typical motor-driven syringe pumps, the design utilizes a compression spring coupled with a clockwork escapement mechanism to advance the syringe plunger. Full control over flow-rate and discrete (bolus) deliveries is achieved through actuation of a clockwork escapement using programmable, low-power electronics. The escapement mechanism allows the syringe plunger to advance a fixed linear distance, delivering a dose size of 0.001 ml in the configuration presented. The modular pump assembly is easily reconfigured for different applications by interchanging components to alter the minimum dose size. Testing to IEC 60601-2-24(2012), the average error of the clockwork syringe pump was 8.0%, 4.0%, and 1.9% for 0.001 ml, 0.002 ml, and 0.01 ml volumes, respectively. An overall mean error of 1.0% was recorded for a flow-rate of 0.01 ml h. Compared to a commercial insulin pump, the clockwork pump demonstrated reduced variability but greater average error due to consistent over-delivery. Further development of the design and/or manufacture should yield a device with similar performance to a commercial pump.
PubMed: 37779821
DOI: 10.1016/j.ohx.2023.e00469 -
Frontiers in Pediatrics 2016Extracorporeal life support (ECLS) is an important device in the management of children with severe refractory cardiac and or pulmonary failure. Actually, two forms of... (Review)
Review
Extracorporeal life support (ECLS) is an important device in the management of children with severe refractory cardiac and or pulmonary failure. Actually, two forms of ECLS are available for neonates and children: extracorporeal membrane oxygenation (ECMO) and use of a ventricular assist device (VAD). Both these techniques have their own advantages and disadvantages. The intra-aortic balloon pump is another ECLS device that has been successfully used in larger children, adolescents, and adults, but has found limited applicability in smaller children. In this review, we will present the "state of art" of ECMO in neonate and children with heart failure. ECMO is commonly used in a variety of settings to provide support to critically ill patients with cardiac disease. However, a strict selection of patients and timing of intervention should be performed to avoid the increase in mortality and morbidity of these patients. Therefore, every attempt should be done to start ECLS "urgently" rather than "emergently," before the presence of dysfunction of end organs or circulatory collapse. Even though exciting progress is being made in the development of VADs for long-term mechanical support in children, ECMO remains the mainstay of mechanical circulatory support in children with complex anatomy, particularly those needing rapid resuscitation and those with a functionally univentricular circulation. With the increase in familiarity with ECMO, new indications have been added, such as extracorporeal cardiopulmonary resuscitation (ECPR). The literature supporting ECPR is increasing in children. Reasonable survival rates have been achieved after initiation of support during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS have reduced in the last 5 years and many centers support patients with functionally univentricular circulations. Improved results have been recently achieved in this complex subset of patients.
PubMed: 27774445
DOI: 10.3389/fped.2016.00109 -
International Journal of Environmental... May 2019The number of patients with gastroesophageal problems taking proton pump inhibitors (PPIs) is increasing. Several studies suggested a possible association between PPIs... (Review)
Review
The number of patients with gastroesophageal problems taking proton pump inhibitors (PPIs) is increasing. Several studies suggested a possible association between PPIs and fracture risk, especially hip fractures, but the relationship remains contentious. This review aimed to investigate the longitudinal studies published in the last five years on the relationship between PPIs and fracture risk. The mechanism underlying this relationship was also explored. Overall, PPIs were positively associated with elevated fracture risk in multiple studies ( = 14), although some studies reported no significant relationship ( = 4). Increased gastrin production and hypochlorhydria are the two main mechanisms that affect bone remodeling, mineral absorption, and muscle strength, contributing to increased fracture risk among PPI users. As a conclusion, there is a potential relationship between PPIs and fracture risks. Therefore, patients on long-term PPI treatment should pay attention to bone health status and consider prophylaxis to decrease fracture risk.
Topics: Hip Fractures; Humans; Incidence; Proton Pump Inhibitors
PubMed: 31060319
DOI: 10.3390/ijerph16091571