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Cerebral autoregulation is an intrinsic myogenic response of cerebral vasculature that allows for preservation of stable cerebral blood flow levels in response to changing systemic blood pressure. It is effective across a broad range of blood pressure levels through precapillary vasoconstriction and dilation. Autoregulation is difficult to directly measure and methods to indirectly ascertain cerebral autoregulation status inherently require certain assumptions. Patients with impaired cerebral autoregulation may be at risk of brain ischemia. One of the central mechanisms of ischemia in patients with metabolically compromised states is likely the triggering of spreading depolarization (SD) events and ultimately, terminal (or anoxic) depolarization. Cerebral autoregulation and SD are therefore linked when considering the risk of ischemia. In this scoping review, we will discuss the range of methods to measure cerebral autoregulation, their theoretical strengths and weaknesses, and the available clinical evidence to support their utility. We will then discuss the emerging link between impaired cerebral autoregulation and the occurrence of SD events. Such an approach offers the opportunity to better understand an individual patient's physiology and provide targeted treatments. [ABSTRACT FROM AUTHOR]

Context: Instrument-assisted Soft Tissue Mobilization (IASTM) is a therapeutic intervention used by clinicians to identify and treat myofascial dysfunction or pathology. However, little is known about the amount of force used by clinicians during an IASTM treatment and how it compares to reports of force in the current literature. Objective: To quantify the range of force applied by trained clinicians during a simulated IASTM treatment scenario. Design: Experimental. Setting: University research laboratory. Participants: Eleven licensed clinicians (physical therapist = 2, chiropractor = 2, and athletic trainer = 7) with professional IASTM training participated in the study. The participants reported a range of credentialed experience from 1 to 15 years (mean = 7 [4.7] y; median = 6 y). Intervention: Participants performed 15 one-handed unidirectional sweeping strokes with each of the 5 instruments for a total of 75 data points each. Force data were collected from a force plate with an attached skin simulant during a hypothetical treatment scenario. Main Outcome Measures: Peak force and average forces for individual strokes across all instruments were identified. Averages for these forces were calculated for all participants combined, as well as for individual participants. Results: The average of peak forces produced by our sample of trained clinicians was 6.7 N and the average mean forces was 4.5 N. Across individual clinicians, average peak forces ranged from 2.6 to 14.0 N, and average mean forces ranged from 1.6 to 10.0 N. Conclusions: The clinicians in our study produced a broad range of IASTM forces. The observed forces in our study were similar to those reported in prior research examining an IASTM treatment to the gastrocnemius of healthy individuals and greater than what has been reported as effective in treating delayed onset muscle soreness. Our data can be used by researchers examining clinically relevant IASTM treatment force on patient outcomes. [ABSTRACT FROM AUTHOR]

Instrument-assisted soft tissue mobilization (IASTM) is a common intervention among clinicians. Despite its popularity, little is known about the forces applied by the clinician using the instruments during treatment. The purpose of this investigation was to examine the forces applied by trained clinicians using IASTM instruments during a simulated treatment. Eleven IASTM–trained (Graston Technique, Técnica Gavilán, or RockBlades) clinicians (physical therapists = 2, chiropractors = 2, athletic trainers = 7) participated in the study. Each clinician performed 75 two-handed strokes distributed evenly across 5 IASTM instruments on a skin simulant attached to a force plate. Instrument-assisted soft tissue mobilization stroke application was analyzed for peak normal forces and mean normal forces by stroke. We observed an average peak normal force of 8.9 N and mean normal force of 6.0 N across all clinicians and instruments. Clinicians and researchers may use the descriptive values as reference for the application of IASTM in practice and research. [ABSTRACT FROM AUTHOR]

Vaccines often require adjuvants to be effective. Traditional adjuvants, like alum, activate the immune response but in an uncontrolled way. Newer adjuvants help to direct the immune response in a more coordinated fashion. Here, we review the opportunity to use the outer membrane vesicles (OMVs) of bacteria as a way to modulate the immune response toward making more effective vaccines. This review outlines the different types of OMVs that have been investigated for vaccine delivery and how they are produced. Because OMVs are derived from bacteria, they have compositions that may not be compatible with parenteral delivery in humans; therefore, we also review the strategies brought to bear to detoxify OMVs while maintaining an adjuvant profile. OMV-based vaccines can be derived from the pathogens themselves, or can be used as surrogate constructs to mimic a pathogen through the heterologous expression of specific antigens in a desired host source strain, and approaches to doing so are reviewed. Additionally, the emerging area of engineered pathogen-specific carbohydrate sequences, or glycosylated OMVs is reviewed and contrasted with protein antigen delivery. Existing OMV-based vaccines as well as their routes of administration round out the text. Overall, this is an exciting time in the OMV field as it matures and leads to more effective and targeted ways to induce desired pathogen-specific immune responses. [ABSTRACT FROM AUTHOR]

The article discusses drug-resistant bacteria have predicted to threaten up to 10 million lives per year by 2050, necessitating new strategies to develop and distribute antibiotics and vaccines. Topics include the iVAX platform promises to accelerate development of new conjugate vaccines with increased access for refrigeration-independent distribution and portable production; and implementation of meningococcal vaccines has significantly reduced the occurrence of bacterial meningitis.

Instrument-assisted soft tissue mobilization (IASTM) is a common intervention among clinicians. Despite the popularity, little is known about the forces applied by the clinician with the instruments during treatment. The purpose of this investigation was to examine the forces applied by trained clinicians using IASTM instruments during a simulated treatment. Eleven IASTM trained (Graston Technique, Técnica Gavilán, or RockBlades) clinicians (Physical Therapist = 2, Chiropractor = 2, Athletic Trainer = 7) participated in the study. Each clinician performed 75 two-handed strokes distributed evenly across five different IASTM instruments on a skin simulant attached to a force plate. IASTM stroke application was analyzed for peak normal forces (Fpeak) and mean normal forces (Fmean) by stroke. We observed an average Fpeak of 8.9N and Fmean of 6.0N across all clinicians and instruments. Clinicians and researchers may use the descriptive values as a reference for application of IASTM in practice and research.