Can Myofascial Interventions Have a Remote Effect on ROM? A Systematic Review and Meta-Analysis

Context: Anatomical and in vivo studies suggest that muscles function synergistically as part of a myofascial chain. A related theory is that certain myofascial techniques have a remote and clinically important effect on range of motion (ROM). Objective: To determine if remote myofascial techniques can effectively increase the range of motion at a distant body segment. Evidence Acquisition: In November 2018, the authors searched 3 electronic databases (CENTRAL, MEDLINE, and PEDro) and hand-searched journals and conference proceedings. Inclusion criteria were randomized controlled trials comparing remote myofascial techniques with passive intervention (rest/sham) or local treatment intervention. The primary outcome of interest was ROM. Quality assessment was performed using the PEDro Scale. Three authors independently evaluated study quality and extracted data. RevMan software was used to pool data using a fixed-effect model. Evidence Synthesis: Eight randomized controlled trials, comprising N = 354 participants were included (mean age range 22–36 y; 50% female). Study quality was low with PEDro scores ranging from 2 to 7 (median scores 4.5/10). None of the studies incorporated adequate allocation concealment and just 2 used blinded assessment of outcomes. In all studies, treatments and outcomes were developed around the same myofascial chain (superficial back line). Five studies included comparisons between remote interventions to sham or inactive controls; pooled results for ROM showed trends in favor of remote interventions (standard mean difference 0.23; 95% confidence intervals; −0.09 to 0.55; 4 studies) at immediate follow-ups. Effects sizes were small, corresponding to mean differences of 9% or 5° in cervical spine ROM, and 1 to 3 cm in sit and reach distance. Four studies compared remote interventions to local treatments, but there were few differences between groups. Conclusions: Remote exercise interventions may increase ROM at distant body segments. However, effect sizes are small and the current evidence base is limited by selection and measurement bias.

Oral Yeast Colonization and Fungal Infections in Peritoneal Dialysis Patients: A Pilot Study

Peritonitis and exit-site infections are important complications in peritoneal dialysis (PD) patients that are occasionally caused by opportunistic fungi inhabiting distant body sites. In this study, the oral yeast colonization of PD patients and the antifungal susceptibility profile of the isolated yeasts were accessed and correlated with fungal infection episodes in the following 4 years. Saliva yeast colonization was accessed in 21 PD patients and 27 healthy controls by growth in CHROMagar-Candida® and 18S rRNA/ITS sequencing. PD patients presented a lower oral yeast prevalence when compared to controls, namely,Candida albicans. Other species were also isolated,Candida glabrataandCandida carpophila. The antifungal susceptibility profiles of these isolates revealed resistance to itraconazole, variable susceptibility to caspofungin, and higher MIC values of posaconazole compared to previous reports. The 4-year longitudinal evaluation of these patients revealedCandida parapsilosisandCandida zeylanoidesas PD-related exit-site infectious agents, but no correlation was found with oral yeast colonization. This pilot study suggests that oral yeast colonization may represent a limited risk for fungal infection development in PD patients. Oral yeast isolates presented a variable antifungal susceptibility profile, which may suggest resistance to some second-line drugs, highlighting the importance of antifungal susceptibility assessment in the clinical practice.

Stability and Instability of Hierarchical Triple Systems

We computed the dynamical evolution of hierarchical triple stars in which both orbits are initially circular, and determine the lower limit to the ratio of periods (outer/inner) for which there is dynamical stability. We found for some mass ratios resonance-like behaviour that occurs in a limited range of initial period ratio. Some resonances are ‘disruptive’; that is, for a small range of initial period ratio we find that the system is not able to settle down to a quasi-steady hierarchical state, but instead disrupts. However, below as well as above this disruptive range there are considerable ranges of initial period ratio where the hierarchical state appears to be stable, at least for the length of integration time we took which was sometimes as much as 10,000 outer orbits. The mass ratios are identified for which different types of unstable behaviour, such as an escape of the distant body without exchange, many exchanges in the limited space without escape, formation of new long-live hierarchy, or an escape of one body after a few exchanges, occur for ratios of periods slightly below the limit of stability. We discuss the relevance of the above behaviour to observed close triples, the closest of which is λ Tau (period ratio 8.3).