Background: Low back pain is a very common problem in adults. The clinical application of intermittent pelvic traction has become the common treatment for lumbar radiculopathy and is also used by clinicians in day to day practice. Only few authors have studied about the effectiveness of self neural tissue mobilization during intermittent pelvic traction. Hence the study was undertaken with an intention to find out the effect of intermittent pelvic traction with and without self neural tissue mobilization on pain and functional disability in patients with lumbar radiculopathy.Methodology: 74 patients with lumbar radiculopathy were included in the study. Subjects were randomly divided into two groups. Group A received only IPT and Group B received IPT with SNTM for 20 minutes with 10 second hold and rest time respectively. The treatment was given initially for 6 days continuously thereafter the treatment was given on alternate days for 1 week. Pre and post intervention pain (VAS) and functional disability (ODI) measures were noted.Results: On comparison between pre and post interventional values of pain and functional disability using paired 't' test, a significant difference (p<0.001) were found in both the groups. As well as the present study showed significant decrease in the pain measurement (p=0.023) and functional disability measures (p=0.043) in group treated with IPT with SNTM.Conclusions: This study concluded that both IPT and IPT with SNTM are effective in both pain and functional disability measures. But when both groups were compared with each other, the IPT with SNTM was more effective than that of IPT alone. So it can be chosen as a treatment for lumbar radiculopathy.
Study question Comparison of uterine contractility (UC) in adenomyosis patients (AP) with and without hormonal contraception (HC) compared to controls with HC, measured by transvaginal ultrasound (TVUS). Summary answer AP with HC show better contraction coordination compared to untreated AP. AP with HC show comparable UC compared to controls with HC. What is known already Adenomyosis is a disease of the uterus that can cause dysmenorrhoea, menorrhagia, dyspareunia and subfertility. These symptoms could be explained by the different contraction patterns in women with adenomyosis compared to healthy controls. Therapeutic use of hormonal contraception reduces the symptoms experienced by women with adenomyosis. This could be explained by the normalization of contraction patterns, which has not yet been objectively quantified due to the absence of a suitable measurement tool. A novel speckle-tracking and strain analysis by 2D TVUS recordings has recently been used to assess differences in contraction coordination, contraction frequency, velocity and direction in healthy women. Study design, size, duration This study is part of an ongoing multi-centre prospective observational cohort study investigating UC on TVUS. Our study includes the TVUS recordings of 23 women with adenomyosis without hormonal contraception treatment, 15 women with adenomyosis undergoing hormonal contraception treatment, and 17 women with healthy uteri undergoing hormonal contraception treatment. Patients were included in 3 centres from 2017 to 2023 (Catharina Hospital Eindhoven, Fertility Clinic Thessaloniki and University Federico Napels). Participants/materials, setting, methods 23 women with sonographic suspicion of adenomyosis without HC, 15 women with adenomyosis undergoing HC treatment and 17 women with healthy uteri with HC were included. HC included oral combined HC, progesterone only pill and hormonal IUD. UC frequency, amplitude, velocity and coordination were assessed by applying a dedicated speckle-tracking and strain analysis to 2-4-minute TVUS recordings in midsagittal section. AP with HC were compared to AP without contraception and to healthy controls with HC. Main results and the role of chance Age, BMI, parity and uterus volume were significantly higher in the women with adenomyosis compared to the healthy controls (p < 0.05). The adenomyosis group with contraception showed more contraction coordination compared to the adenomyosis group without hormonal contraception treatment (0.23 ±0.10 vs. 0.29 ±0.11, p = 0.041). There was a tendency towards higher contraction frequency (1.53 ±0.21 vs. 1.42, p = 0.153) and lower amplitude (0.56 ±0.04 vs. 0.65 ±0.04, p = 0.159) in the adenomyosis group with hormonal contraception treatment compared to the adenomyosis group without hormonal contraception treatment. There were no significant differences in uterine contractility between the adenomyosis group with hormonal contraception treatment compared to the healthy group with hormonal contraception treatment. Limitations, reasons for caution No sub-analysis was done to assess effects of additional adenomyosis and contraception characteristics due to this being an ongoing study. Women with extensive adenomyosis were not included due to impossibility to perform analysis of ultrasound recordings. AP were older, had higher BMI and larger uterus volumes than healthy controls. Wider implications of the findings The normalization of UC under therapeutic use of HC compared to untreated AP and the lack of differences in UC between AP and healthy controls with HC, confirms the therapeutic effect on adenomyotic symptoms. This presents a new therapeutic efficacy marker for adenomyosis. Trial registration number NL52466.100.15 Study funding Yes Funding source Funding by commercial/corporate company(ies)
Study question What is the influence of uterine contractility of in-vitro fertilisation (IVF) patients at follicle aspiration (FA) and embryo transfer (ET) on clinical pregnancy outcomes? Summary answer At time of embryo transfer, a lower contraction frequency, and increased contraction coordination is associated with more favourable chances of ongoing pregnancy after IVF/ICSI treatment. What is known already Uterine peristalsis is the rhythmic, wave-like motion of the subendometrial layer of the uterus. Various subjective methods using visual interpretation suggest that uterine peristalsis features are different in the various stages of the menstrual cycle, and they are thought to be important for fertility and early embryo implantation. Recently, a new automated quantitative method to measure uterine contractility was validated in a small number of IVF patients to analyse uterine peristalsis on transvaginal ultrasound (TVUS) recordings with speckle-tracking. With this method a new contraction feature – coordination – can be assessed alongside frequency, direction, amplitude. Study design, size, duration This study is part of an ongoing multi-centre prospective observational cohort study investigating uterine contractility on TVUS. Our study included patients undergoing IVF/ICSI treatment with good quality TVUS recordings from 2017 to 2023. Patients received fresh ET on Day 3 or Day 5. Participants/materials, setting, methods 128 IVF/ICSI patients undergoing fresh ET were included from participating centres. Patients underwent TVUS within 1 hour prior to FA(n = 61/128), and/or within one hour before ET (n = 67/128). Uterine contraction frequency (CF), amplitude, velocity and coordination were measured by applying dedicated speckle tracking and strain analysis. The primary outcome was ongoing pregnancy (OP, viable pregnancy >10 weeks gestational age). The independent T-test and Mann-Whitney U test were applied to compare features between groups. Main results and the role of chance 39.1% of the IVF/ICSI patients (50/128) achieved ongoing pregnancy. Most patients underwent IVF/ICSI treatment due to a male factor (29.0%) or idiopathic subfertility (31.9%). Age, BMI and embryo quality were comparable for the pregnant vs. non-pregnant groups (p > 0.05 for all). CF was significantly higher during FA vs. ET (1.70±0.26 vs. 1.54±0.23,[RC(1] p < 0.001), as well as contraction velocity (0.79±0.22 vs 0.63±0.16, p < 0.001). Contraction amplitude was also lower during ET vs. FA (0.06 IQR 0.03 vs. 0.08 IQR 0.04, p < 0.001[RC(2] ). During FA, no significant differences were seen in contraction features for pregnant vs. non-pregnant groups (all p > 0.05). At ET, a lower mean CF was significantly associated with OP(1.46 ±0.18 vs. 1.57±0.19 [RC(3] contraction/min, p = 0.016), as well as presence of more coordinated uterine contractions (0.22 ±0.09 vs. 0.33±0.14, p < 0.001[RC(4] ). No significant differences were found for the features of amplitude and velocity. Limitations, reasons for caution Further validation of these results is ongoing, including expansion of the sample size. No sub-analysis has yet been done to assess the effect of additional IVF/ICSI treatment characteristics (i.e. stimulation protocol, type of subfertility) on uterine contractility and chance of pregnancy. Wider implications of the findings Uterine contractility changes its character depending on the timing of IVF treatment, with different characteristics seen at FA vs. ET. The most favourable contraction profile for ongoing pregnancy after ET seems to be uterine contractions with relatively low frequency and good coordination. These findings may support decision-making at ET. Trial registration number not applicable
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