M.Tech. / Purpose: The aim of this study was to evaluate the relative effectiveness of the application of soft tissue massage to the posterior neck muscles before, and after, chiropractic adjustment to the cervical spine in the treatment of cervical facet syndrome. To determine the most effective treatment protocol; the patient‟s perceptions and objective findings were used. These findings were assessed by completing a Visual Analogue Scale, a McGill Pain Questionnaire and a Vernon-Mior Neck Pain and Disability Index, and measuring the cervical spine range of motion using a Cervical Range of Motion goniometer. The questionnaires were completed and the ROM readings taken prior to treatment on the first, fourth and seventh visits. Method: Forty participants who met the inclusion criteria were randomly allocated to two different groups of twenty each. One group received soft tissue massage to the posterior neck musculature prior to the application of chiropractic adjustments to the subluxations of the cervical spine. The second group received the chiropractic adjustments to subluxations of the cervical spine that was followed by soft tissue massage to the posterior neck. Treatment took place over a period of three weeks, and participants were treated six times out of a total of seven visits. Procedure: Subjective data was collected at the first and fourth visit prior to treatment, as well as on the seventh visit by means of a Visual Analogue Scale (VAS), McGill Pain Questionnaire as well as a Vernon-Mior Neck Pain and Disability Index to assess pain and disability levels. Objective data was collected at the first and fourth visit prior to treatment, and at the seventh visit by means of a Cervical Range of Motion goniometer (C.R.O.M.). Data collected was analysed by STATCON. Results: Both groups improved well over time subjectively and objectively but none more superior. Statistically significant improvements in group 1 and group 2 were noted over the duration of the study with regards to pain, disability, and cervical spine range of motion.

Timely reperfusion after a myocardial infarction is necessary to salvage the ischemic region; however, reperfusion itself is a major contributor to the final tissue damage. Currently, there is no clinically relevant therapy available to reduce ischemia-reperfusion injury. While many drugs have shown promise in reducing ischemia-reperfusion injury in preclinical studies, none of these drugs have demonstrated benefit in large clinical trials. Part of the failure to translate therapies can be attributed to the reliance on small animal models for preclinical studies. While animal models encapsulate the complexity of the systemic in vivo environment, they do not fully recapitulate human cardiac physiology. In this thesis, we utilized cardiac tissue engineering methods in conjunction with cardiomyocytes derived from human induced pluripotent stem cells, to establish a biomimetic human tissue-engineered model of ischemia-reperfusion injury. The resulting cardiac constructs were subjected to simulated ischemia or ischemia-reperfusion injury in vitro. We demonstrated that the presence of reperfusion injury can be detected and distinguished from ischemic injury. Furthermore, we demonstrated that we were able to detect changes in reperfusion injury in our model following ischemic preconditioning, modification of reperfusion conditions, and addition of cardioprotective therapeutics. This work establishes the utility of the human tissue model in studying ischemia-reperfusion injury and the potential of the human tissue platform to help translate therapeutic strategies into the clinical setting.

Lam Yuk Lan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 147-167). / Abstracts in English and Chinese. / ABSTRACT --- p.i / 摘要 --- p.iii / ACKNOWLEDGEMENTS --- p.v / PUBLICATIONS --- p.vii / TABLE OF CONTENTS --- p.ix / LIST OF FIGURES --- p.xiii / LIST OF TABLES --- p.xiv / LIST OF ABBREVIATIONS --- p.xvi / Chapter Section 1: --- Background --- p.1 / Chapter Chapter 1: --- Cell-free circulating DNA --- p.1 / DNA and Man --- p.2 / Cell-free Circulating DNA in Plasma and Serum --- p.4 / The Discovery and Early Development --- p.4 / Clinical Implications --- p.5 / Cancers --- p.5 / Prenatal diagnosis --- p.11 / Pregnancy abnormalities --- p.14 / Organ transplantation --- p.15 / Trauma and post-traumatic complications --- p.15 / "Origin, Mechanisms and Characteristics" --- p.16 / Methods of Analysis --- p.22 / Chapter Chapter 2: --- Trauma and Organ Failure --- p.25 / Trauma and Society --- p.25 / The Problem of Organ Failure --- p.26 / Definitions --- p.27 / Pathogenesis --- p.228 / Inflammation --- p.29 / Predictions --- p.30 / Trauma Scoring Systems --- p.31 / Abbreviated Injury Scale --- p.32 / Injury Severity Score --- p.32 / Other scoring systems --- p.33 / Definition of Trauma --- p.33 / Chapter Chapter 3: --- Stroke --- p.35 / The Burden of Stroke --- p.35 / What is a Stroke ？ --- p.36 / The Causes --- p.40 / Pathophysiology --- p.41 / Diagnosis and Tests --- p.42 / Assessments and prognosis --- p.44 / Biochemical Markers --- p.47 / Chapter Chapter 4: --- Aims of the study --- p.48 / Chapter Section 2: --- Materials and Methods --- p.50 / Chapter Chapter 5: --- Methods of analysis on cell-free circulating DNA --- p.51 / Materials --- p.51 / DNA Extraction from the Plasma Samples --- p.51 / Real-time Quantitative PCR --- p.52 / Methods --- p.54 / DNA Extraction from the Plasma Samples --- p.54 / Real-time Quantitative PCR --- p.56 / Principle --- p.56 / The β-globin TaqMan Assay --- p.59 / Calibration of the β-globin TaqMan System --- p.62 / Contamination Control --- p.64 / Chapter Section 3: --- Cell-free circulating DNA after trauma --- p.65 / Chapter Chapter 6: --- Cell-free circulating DNA concentration as a prognostic marker in patients after trauma --- p.66 / Introduction --- p.66 / Methods --- p.68 / Results --- p.71 / Discussion --- p.84 / Chapter Chapter 7: --- Temporal changes of cell-free circulating DNA after trauma --- p.89 / Introduction --- p.89 / Methods --- p.90 / Results --- p.92 / Discussion --- p.106 / Chapter Section 4: --- Cell-free circulating DNA concentration after stroke --- p.109 / Chapter Chapter 8: --- Cell-free circulating DNA concentration in patients with stroke --- p.110 / Introduction --- p.110 / Methods --- p.111 / Results --- p.115 / Discussion --- p.129 / Chapter Chapter 9: --- Daily changes of cell-free circulating DNA concentration after stroke --- p.132 / Introduction --- p.132 / Methods --- p.132 / Results --- p.133 / Discussion --- p.137 / Chapter Section 5: --- Conclusion and future perspectives --- p.139 / Chapter Chapter 10: --- Conclusion and Future Perspectives --- p.140 / Conclusion --- p.140 / Future perspectives --- p.145 / BIBLIOGRAPHY --- p.147 / APPENDIX 1: Goriśةmultiple organ failure score --- p.168 / "APPENDIX 2: Definitions and criteria for ARDS, ALI and MODS" --- p.170 / APPENDIX 3: Computed axial tomography and magnetic resonance imaging --- p.172 / APPENDIX 4: Glasgow Coma Scale --- p.173 / APPENDIX 5: Post-Stroke Modified Rankin Scale --- p.174

Thesis (Ph. D. in Biomedical Engineering)--Vanderbilt University, Aug. 2002. / Title from title screen. Includes bibliographical references.

The response of porcine adipose and skeletal muscle tissues to shock compression has been investigated using the plate-impact technique in conjunction with manganin foil pressure gauge diagnostics. This approach has allowed for measurement of the levels of uniaxial stress imparted to both skeletal muscle and rendered adipose tissue by the shock. In addition, the lateral stress component generated within adipose tissue during shock loading has also been investigated. The techniques employed in this study have allowed for equation-of-state relationships to be established for the investigated materials, highlighting non-hydrodynamic behaviour in each type of tissue over the range of investigated impact conditions. While the adipose tissue selected in this work has been shown to strengthen with impact stress in a manner similar to that seen to occur in polymeric materials, the skeletal muscle tissues exhibited a ow strength, or resistance to compression, that was independent of impact stress. Both the response of the adipose material and tested skeletal muscle tissues lie in contrast with the shock response of ballistic gelatin, which has previously been shown to exhibit hydrodynamic behaviour under equivalent loading conditions. Plate-impact experiments have also been used to investigate the shock response of a homogenized variant of one of the investigated muscle tissues. In the homogenized samples, the natural structure of skeletal muscle tissue, i.e. a fibrous and anisotropic composite, was heavily disrupted and the resulting material was milled into a fine paste. Rather than matching the response of the unaltered tissues, the datapoints generated from this type of experiment were seen to collapse back on to the hydrodynamic response predicted for skeletal muscle by its linear equation-of-state (Us = 1.72 + 1.88up). This suggests that the resistance to compression apparent in the data obtained for the virgin tissues was a direct result of the interaction of the shock with the quasi-organized structure of skeletal muscle. A soft-capture system has been developed in order to facilitate post-shock analysis of skeletal muscle tissue and to ascertain the effects of shock loading upon the structure of the material. The system was designed to deliver a one-dimensional, at-topped shock pulse to the sample prior to release. The overall design of the system was aided by use of the non-linear and explicit hydrocode ANSYSR AUTODYN. Following shock compression, sections of tissue were imaged using a transmission electron microscope (TEM). Both an auxetic-like response and large-scale disruption to the I-band/Z-disk regions within the tissue's structure were observed. Notably, these mechanisms have been noted to occur as a result of hydrostatic compression of skeletal muscle within the literature.

A "Job Coach" model was developed based on sports medicine and rehabilitation principles for athletes, and individual placement and supported employment for people with psychiatric disabilities. This is a biopsychosocial model, emphasising workplace-based intervention. / Background. Occupational musculoskeletal soft tissue injuries represent a major source of work disability. There has been a gradual rise in the occurrence of occupational musculoskeletal injuries of the upper extremity, including both acute injuries and more chronic health problems. Return to work following an occupational injury is a multifactoral process, although traditional clinic-based rehabilitation programmes do not appreciate the importance of contextual factors. / Conclusion. Workplace work hardening programmes are a further development of work rehabilitation programmes. The therapeutic use of actual work facilities and the work environment can effectively facilitate the successful return to work process of the injured worker. More importantly, many of the psychosocial problems associated with separation from the work routine, peer group and/or the employer are minimised by the presence of the Job Coach. The results of this study confirm that workplace-based rehabilitation intervention is more effective than conventional clinic-based rehabilitation programmes in terms of prevention of further work disability, improvement in functional capabilities and decrease in perceived pain and disability. / Keywords. Job coach, workplace-based rehabilitation, rotator cuff injury, work disability, return to work intervention. / Methodology. A randomised controlled trial was conducted on 94 workers recruited from Workers' Compensation insurers. These workers had all sustained occupational rotator cuff injury and had lost more than 90 workdays. The workers were randomly assigned into control or experimental groups. The control group received a traditional work hardening programme and the experimental group received a workplace work hardening programme using the Job Coach model. The return to work outcomes of the two groups were compared. Areas of comparison included return to work rate after training, job retention ability and impact on earning capacity. Other outcome measures included change in active range of motion of the shoulder joint, eight basic functional capacities and the worker's perception of shoulder pain and disability based on the Shoulder Pain and Disability Index (SPADI). / Results. After one-month of the training programme, a higher return to work rate was obtained in the experimental group compared to the control group (71.4% against 37%, chi2=11.095, p=0.001). For job retention ability, 93.5% of the workers in the experimental group were still at work compared to 72.9% of workers in the control group (chi 2=7.031, p=0.008). No obvious salary change was noted between the two groups. / The SPADI was statistically significantly lower in the experimental group than in the control group (p=0.032), meaning that workers in the experimental group had fewer shoulder problems after training. Other significant improvements were noted in active shoulder flexion (p=0.001), arm lift strength (p=0.01), high-near lift strength (p=0.014), dynamic carrying strength (p=0.007) and overhead work tolerance (p=0.032), all of which were found to be statistically significantly higher in the experimental group than in the control group. / Cheng Shu-kei. / "July 2006." / Adviser: Leung Kim Hung. / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1568. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 216-238). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

The response of porcine adipose and skeletal muscle tissues to shock compression has been investigated using the plate-impact technique in conjunction with manganin foil pressure gauge diagnostics. This approach has allowed for measurement of the levels of uniaxial stress imparted to both skeletal muscle and rendered adipose tissue by the shock. In addition, the lateral stress component generated within adipose tissue during shock loading has also been investigated. The techniques employed in this study have allowed for equation-of-state relationships to be established for the investigated materials, highlighting non-hydrodynamic behaviour in each type of tissue over the range of investigated impact conditions. While the adipose tissue selected in this work has been shown to strengthen with impact stress in a manner similar to that seen to occur in polymeric materials, the skeletal muscle tissues exhibited a ow strength, or resistance to compression, that was independent of impact stress. Both the response of the adipose material and tested skeletal muscle tissues lie in contrast with the shock response of ballistic gelatin, which has previously been shown to exhibit hydrodynamic behaviour under equivalent loading conditions. Plate-impact experiments have also been used to investigate the shock response of a homogenized variant of one of the investigated muscle tissues. In the homogenized samples, the natural structure of skeletal muscle tissue, i.e. a fibrous and anisotropic composite, was heavily disrupted and the resulting material was milled into a fine paste. Rather than matching the response of the unaltered tissues, the datapoints generated from this type of experiment were seen to collapse back on to the hydrodynamic response predicted for skeletal muscle by its linear equation-of-state (Us = 1.72 + 1.88up). This suggests that the resistance to compression apparent in the data obtained for the virgin tissues was a direct result of the interaction of the shock with the quasi-organized structure of skeletal muscle. A soft-capture system has been developed in order to facilitate post-shock analysis of skeletal muscle tissue and to ascertain the effects of shock loading upon the structure of the material. The system was designed to deliver a one-dimensional, at-topped shock pulse to the sample prior to release. The overall design of the system was aided by use of the non-linear and explicit hydrocode ANSYSR AUTODYN. Following shock compression, sections of tissue were imaged using a transmission electron microscope (TEM). Both an auxetic-like response and large-scale disruption to the I-band/Z-disk regions within the tissue's structure were observed. Notably, these mechanisms have been noted to occur as a result of hydrostatic compression of skeletal muscle within the literature.

Ankle sprains are one of the most common musculoskeletal injuries. Physiotherapy treatment and advice to rest, use ice, use compression, and elevate the ankle (RICE advice) is believed to speed up the functional recovery and enhance healing associated with acute ankle sprains. However, there is limited evidence to support the efficacy of RICE treatment. This study investigated whether physiotherapy (including RICE advice) was as effective as RICE advice alone in improving the time to recovery in a clinical situation.The evidence for RICE advice was reviewed along with the different treatment modalities currently used by physiotherapists in New Zealand for acute ankle sprain. This review highlighted the low number and poor quality of studies investigating RICE and early intervention physiotherapy management for ankle sprains. RICE principals appear to be relatively inexpensive and somewhat effective for pain relief and may reduce further tissue damage in the acute stage of Grade I and II ankle sprains. Evidence extrapolated from studies investigating the use of post surgical ice appears to support the use of ice in the acute stage of an ankle sprain to minimise bleeding and oedema. The intermittent application of ice is more effective for pain relief in the acute phase than sustained icing. Physiotherapy interventions such as TENS for pain relief and bracing for the support of Grade II - III ankle sprains have been shown to be beneficial for pain relief in the acute phase. A need for further high quality, randomised controlled trials (RCT's) was identified.Subsequently a RCT was conducted with 28 participants to investigate the difference between (a) early intervention physiotherapy management combined with RICE advice, and (b) self management RICE advice without physiotherapy.Twenty eight individuals (males n = 22, females n = 6), between the ages of 16 and 40 with acute ankle sprains, who met the inclusion criteria, were approached by physiotherapists working on this project and invited to participate. Dependant variables were pain, function, swelling, compliance and medication use up to Day 11 post injury. Swelling, pain and function were measured over three assessments on Days 1, 3 and 11, using volumetric analysis, a visual analogue scale (VAS) and a functional question derived from a validated functional questionnaire respectively. Medication use and compliance were elicited from information gathered in a participant home diary. Both groups were similar on Day 1 in respect to their initial pain, swelling, the number of participants who were referred for X-rays, and the time taken to present to the physiotherapist. However the RICE group had significantly higher function scores (p = 0.042). The RICE group also had a significantly higher use of medication on Day 1 (p = 0.035) and Day 11 (p = 0.048). For both groups there was a statistically significant decrease in swelling (p = 0.003), pain scores (p = 0.000), and an increase in function scores (p = 0.000) in relation to time over the eleven days of assessment. The physiotherapy group had significantly improved function scores (p = 0.042) from Day 1 to Day 11 compared to the RICE group. There were no significant differences between groups for swelling, pain scores, and their first day of documented non-compliance. The within day range of error in the volumetric measurements was within 189.9 ml and 1.2 ml. Three trials were conducted per person within a Day session. The first volumetric analysis was significantly less than the subsequent two measurements (p = 0.040).It was concluded that, in the early stage of an ankle injury both physiotherapy and RICE, and RICE advice alone, resulted in significant improvements in swelling, pain and function. Early intervention physiotherapy was significantly better at improving the functional ability of participants by Day 11. Early intervention physiotherapy may also identify complications associated with ankle sprains.Despite its limitations this research could potentially lead to changes in the standard treatment protocols for soft tissue ankle injuries. Implementation of self management RICE by patients in the acute stage would initially reduce the cost of physiotherapy treatments, and may lead to equal improvements in pain and swelling outcomes. However, it appears that physiotherapy may lead to better functional outcomes which would reduce the costs associated with time off work, and rehabilitation. It is important to note that these findings are based on a small sample size and on Grade I or II ankle ligament sprains, and that treatment for more severe ankle injuries may be better with physiotherapy, or surgery, rather than self management RICE by patients. Findings contribute to the growing body of 'best practice' evidence for health practitioners. Keywords: Acute soft tissue injuries, ankle, sprain, early intervention, physiotherapy, RICE, volumetric measurement.

Ankle sprains are one of the most common musculoskeletal injuries. Physiotherapy treatment and advice to rest, use ice, use compression, and elevate the ankle (RICE advice) is believed to speed up the functional recovery and enhance healing associated with acute ankle sprains. However, there is limited evidence to support the efficacy of RICE treatment. This study investigated whether physiotherapy (including RICE advice) was as effective as RICE advice alone in improving the time to recovery in a clinical situation.The evidence for RICE advice was reviewed along with the different treatment modalities currently used by physiotherapists in New Zealand for acute ankle sprain. This review highlighted the low number and poor quality of studies investigating RICE and early intervention physiotherapy management for ankle sprains. RICE principals appear to be relatively inexpensive and somewhat effective for pain relief and may reduce further tissue damage in the acute stage of Grade I and II ankle sprains. Evidence extrapolated from studies investigating the use of post surgical ice appears to support the use of ice in the acute stage of an ankle sprain to minimise bleeding and oedema. The intermittent application of ice is more effective for pain relief in the acute phase than sustained icing. Physiotherapy interventions such as TENS for pain relief and bracing for the support of Grade II - III ankle sprains have been shown to be beneficial for pain relief in the acute phase. A need for further high quality, randomised controlled trials (RCT's) was identified.Subsequently a RCT was conducted with 28 participants to investigate the difference between (a) early intervention physiotherapy management combined with RICE advice, and (b) self management RICE advice without physiotherapy.Twenty eight individuals (males n = 22, females n = 6), between the ages of 16 and 40 with acute ankle sprains, who met the inclusion criteria, were approached by physiotherapists working on this project and invited to participate. Dependant variables were pain, function, swelling, compliance and medication use up to Day 11 post injury. Swelling, pain and function were measured over three assessments on Days 1, 3 and 11, using volumetric analysis, a visual analogue scale (VAS) and a functional question derived from a validated functional questionnaire respectively. Medication use and compliance were elicited from information gathered in a participant home diary. Both groups were similar on Day 1 in respect to their initial pain, swelling, the number of participants who were referred for X-rays, and the time taken to present to the physiotherapist. However the RICE group had significantly higher function scores (p = 0.042). The RICE group also had a significantly higher use of medication on Day 1 (p = 0.035) and Day 11 (p = 0.048). For both groups there was a statistically significant decrease in swelling (p = 0.003), pain scores (p = 0.000), and an increase in function scores (p = 0.000) in relation to time over the eleven days of assessment. The physiotherapy group had significantly improved function scores (p = 0.042) from Day 1 to Day 11 compared to the RICE group. There were no significant differences between groups for swelling, pain scores, and their first day of documented non-compliance. The within day range of error in the volumetric measurements was within 189.9 ml and 1.2 ml. Three trials were conducted per person within a Day session. The first volumetric analysis was significantly less than the subsequent two measurements (p = 0.040).It was concluded that, in the early stage of an ankle injury both physiotherapy and RICE, and RICE advice alone, resulted in significant improvements in swelling, pain and function. Early intervention physiotherapy was significantly better at improving the functional ability of participants by Day 11. Early intervention physiotherapy may also identify complications associated with ankle sprains.Despite its limitations this research could potentially lead to changes in the standard treatment protocols for soft tissue ankle injuries. Implementation of self management RICE by patients in the acute stage would initially reduce the cost of physiotherapy treatments, and may lead to equal improvements in pain and swelling outcomes. However, it appears that physiotherapy may lead to better functional outcomes which would reduce the costs associated with time off work, and rehabilitation. It is important to note that these findings are based on a small sample size and on Grade I or II ankle ligament sprains, and that treatment for more severe ankle injuries may be better with physiotherapy, or surgery, rather than self management RICE by patients. Findings contribute to the growing body of 'best practice' evidence for health practitioners. Keywords: Acute soft tissue injuries, ankle, sprain, early intervention, physiotherapy, RICE, volumetric measurement.

Thesis (D.Phil.(Biokinetics, Sport and Leisure Sciences))--University of Pretoria, 2008. / Summary in English and Afrikaans. Includes bibliographical references.