Low back pain (LBP) is a common musculoskeletal complaint that can impede physical function and mobility. Current management often involves pain medication, but there is a need for non-pharmacological and non-invasive interventions. Soft tissue manipulation (STM) such as massage has been shown to be effective in human subjects, but the molecular mechanisms underlying these findings are not well understood. In this paper, we evaluated potential changes in soft tissue levels of more than thirty pro- or anti-inflammatory cytokines following instrument-assisted STM (IASTM) in rats with chronic, induced LBP using Complete Freund’s Adjuvant. Our results indicate that IASTM is associated with reduced soft tissue levels of RANTES/CCL5 and increased soft tissue levels of IL-4, which are pro-inflammatory and anti-inflammatory factors, respectively, by 120 minutes post-treatment. IASTM was not associated with tissue-level changes in CXCL5/LIX (the murine homologue of IL-8), CXCL7, GM-CSF ICAM-1, IL1-ra, IL-6, IP-10/CXCL10, L-selectin, TNF-α, or VEGF at either 30- or 120 minutes post-treatment. Combined, our findings suggest that IASTM exerts tissue-level effects that are associated with improved clinical outcomes and potentially beneficial changes in pro/anti-inflammatory cytokines in circulation and at the tissue level.
e21638 Background: The aim of this study was to identify predictors of overall survival (OS) following palliative pleural procedures in patients with malignant pleural effusion (MPE). Methods: Data was collected from our database between January 2012 and December 2016 including all patients with MPE. All patients were followed-up for at least 30 days after the pleural procedure. We evaluated radiological aspects, biochemical and hematologic parameters as well as clinical features. For OS analysis, patients were divided into two groups. Group I included OS < 30 days and Group II included OS > 30 days. Prognostic factors for OS were identified by univariate analysis, using Fisher's exact for the categorical variables and Student's t-test for the quantitative ones. The cutoff points for any significant continuous variables were determined by the ROC curve. Subsequently, significant variables were entered into a multivariate logistic regression analysis ( p < 0.05). Results: A total of 238 patients were included in the analysis (37,6% males). Median age was 62 year-old (range 24-965) and median follow-up time for surviving patients was 127 days. Median OS was 83 days for therapeutic pleural aspiration (TPA), 353 days for pleurodesis, 135 days for VAT drainages without pleurodesis due to trapped lung and 39 days for indwelling pleural catheter. Regarding primary site, median OS was 170 days for lung (n = 91), 253 days for breast (n = 70), 90 days for gynecological (n = 18), 33 for gastrointestinal (n = 34) and 305 days for others (n = 26). Factors affecting OS in univariate analysis with p < 0.0001 were ECOG, procedure, protein, albumin, neutrophil to lymphocyte ratio(NLR) and hemoglobin, pulmonary infiltrate (p < 0.0438), hematocrit (p < 0.0002), and chemotherapy line (p < 0.0229). In multivariate analysis the following variables were identified as independent prognostic factor: ECOG 3/4 (p < 0.0095), pulmonary infiltrate (p < 0.0011), albumin < 2.5 (p < 0.0325), and hematocrit < 35 (p < 0.0055). Conclusions: Patients with MPE who presented with ECOG 3/4, pulmonary infiltrate, albumin < 2.5 and hematocrit < 35 had shorter OS. The identification of these prognostic factors may assist physicians in choosing the optimal palliative technique.
e21666 Background: The aim of this study was to identify predictors of overall survival (OS) and recurrence after palliative pleural procedures in patients with malignant pleural effusion (MPE) and high-risk tumors according to the LENT Score. Methods: Data was collected from our database between January 2013 and December 2015 of patients with MPE and high-risk tumors according to the LENT Score. All patients were followed-up for at least 30 days after the pleural procedure. We evaluated radiological aspects, biochemical and hematologic parameters as well as clinical features. For OS analysis, patients were divided into two groups. Group I included OS < 30 days and group II included OS > 30 days. Prognostic factors for pleural recurrence and OS were identified by univariate analysis, using Fisher's exact and Student's t-test. Subsequently, significant variables were entered into a multivariate logistic regression analysis ( p < 0.05). Results: A total of 134 patients were included. Median follow-up time for surviving patients was 56 (range: 2-623) days. High-risk primary tumors included lung (66.4%), gastrointestinal (24.6%) , sarcoma (3.7%), urologic (3.7%) and others (1.5%). Forty-four patients in Group I had OS < 30 days while 22 patients had MPE recurrence. Factors affecting OS in univariate analysis were: type of procedure, ECOG, albumin, leukocytes, neutrophil to lymphocyte ratio( NRL) and hemoglobin. Factors affecting recurrence were: type of procedure, chemotherapy line (CT), albumin and platelets. In multivariate analysis for Group I, type of procedure (therapeutic pleural aspiration – TPA) ( p= 0.011), ECOG 3/4 ( p= 0.004), NLR > 5 ( p= 0.037) and leukocytes > 8000 ( p= 0.042) were identified as independent predictors of OS. In terms of recurrence, only CT beyond first line ( p = 0.042) was identified as an independent prognostic factor. Conclusions: Patients with MPE who underwent TPA, had ECOG 3/4, leukocytes > 8000, and NLR > 5 were significantly associated with shorter OS,. CT beyond first line was associated with recurrence. The identification of these prognostic factors may assist physicians in choosing the optimal palliative technique.
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