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Background: Manual therapy (MT) is frequently used in combination with management of osteoarthritis of the knee, but there is no consensus on the exact efficacy of this treatment strategy. The purpose of this systematic review and meta-analysis was to evaluate the pain relief and safety of MT for treatment of knee osteoarthritis (KOA). Methods: Randomized controlled trials evaluating MT in patients with KOA in major English and Chinese journals were searched in the following databases: Wanfang, China Science and Technology Journal Database (VIP database), China National Knowledge Infrastructure (CNKI), PubMed, Embase, Web of Science, and the Cochrane Library databases through June 2023. The methodological quality and quality of evidence of the included studies were assessed using Cochrane's risk-of-bias 2 (ROB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Data analysis was performed using Stata version 15.0 software. After use of Galbraith plots to exclude studies that could lead to heterogeneity, random effects models were used to analyze the remaining data and test the consistency of the findings. We used meta-regression to assess the effect of treatment period, patient age, and sex ratio on outcomes. Funnel plots and Egger's test were used to evaluate publication bias. Sensitivity analyses were used to determine the reliability of the results. Results: A total of 25 studies, with 2376 participants, were included in this review. The overall methodological quality of the included studies was limited. Our findings suggest that MT has a positive impact on pain relief outcomes in KOA patients. The meta-analysis showed that MT was superior to usual care (SMD = 2.04, 95% CI 0.94, 3.14, I2 = 96.3%; low evidence quality) and exercise (SMD = 1.56, 95% CI 0.41, 2.71, I2 = 96.3%; low evidence quality) for reducing pain. In terms of improvement in visual analogue scale (VAS) scores, MT treatment beyond 4 weeks (SMD = 1.56, 95% CI 0.41, 2.71, I2 = 96.3%) may be superior to treatments less than or equal to 4 weeks (SMD = 1.24, 95% CI 0.56, 1.95, I2 = 94.7%). No serious adverse events associated with MT were reported. Conclusions: MT may be effective at reducing pain in patients with KOA and may be more effective after a 4-week treatment period. Compared with usual care and exercise therapy, MT may be superior at reducing KOA pain in the short term (9 weeks), but its long-term efficacy requires careful consideration of evidence-based outcomes. MT appears to be safe for KOA patients, though clinicians should inform patients of the potential risk of MT-related adverse events. [ABSTRACT FROM AUTHOR]

The bottom friction velocity (U*), which controls seabed erosion and deposition, plays a critical role in sediment transport in tidal coastal bottom boundary layers. Approaches have been proposed to calculate U*, including the log profile (LP) estimation, the direct covariance (COV) measurement, and the turbulent kinetic energy (TKE) method. However, the LP method assumes homogeneous flow and the effects of stratification need to be taken into account. Here, field investigations of hydrodynamics and sediment dynamics were carried out on the Jiangsu Coast, China. Two acoustic Doppler velocimeters (ADV) velocity measurements at 0.2 and 1 m above the seabed have been used to estimate U*, based on the aforementioned three methods. The COV and TKE methods provided reasonable estimations of U*, while a pronounced overestimation was identified when using the LP method. This overestimation can be attributed to the stratification effects associated with the vertical suspended sediment concentration (SSC) gradient near the bottom. Then, three models were utilized to correct the overestimation, in which the gradient/flux Richardson number was modified with empirical constants α, β, and A to parameterize the stratification effects in the logarithmic velocity distribution. The values of α, β, and A derived from the observation are smaller than the results from previous investigations. These modified logarithmic velocity distribution models can be applied in numerical simulations when sediment stratification is important. [ABSTRACT FROM AUTHOR]

Understanding mechanisms of suspended sediment transport in estuaries is critical for predicting estuarine geomorphic evolution, managing navigation and fisheries, and monitoring the health of estuarine ecosystems. Yet monitoring suspended sediment transport in estuaries is challenging due to the influences of both riverine and marine processes, and traditional in situ observations cannot directly differentiate contributions of multiple physical processes (e.g., advection and resuspension/settling). Here we investigated the effects of advection and sediment resuspension/settling on suspended sediment transport within the turbidity maximum zone at the South Passage of the Changjiang Estuary. The Changjiang catchment is notable for its long history of intensive human activities including dam construction, which has caused significant geomorphic changes along the river and its estuary. We conducted synchronized hydrodynamic measurements at three monitoring stations along the river channel and imported time series of current velocity and suspended sediment concentration (SSC) at these stations into a simplified, one-dimensional box model to separate in situ SSC into advection- and resuspension/settling-induced components. Our results show that high SSC consisted of a background SSC of 0.93 kg m−3 maintained by advection that contributes to 97.9% of the total average SSC, and a fluctuating SSC controlled by sediment resuspension and settling. The background SSC was higher than the fluctuating SSC at all times, indicating that sediment advection was stronger than local sediment resuspension in the river channel. We compared time series of SSC components, bed-level change and suspended sediment transport rates in the South Passage with previous observations in the nearby subaqueous delta, and found that the South Passage of the Changjiang Estuary experienced net accretion during summer because of the relatively high background SSC maintained by advection of fluvial sediment. In contrast, the subaqueous delta experienced erosion due to strong local sediment resuspension and weak sediment delivery by advection. Our results highlight the spatial variability in the magnitudes of sediment advection and resuspension/settling as key drivers of geomorphic changes of deltas and estuarine channels in response to sediment reduction caused by upstream dam construction. • A box model was used to estimate the sediment budget within the Changjiang Estuary. • Suspended sediment transport in the estuarine channel was maintained by advection. • Sediment from the river and the subaqueous delta contributed to channel accretion. [ABSTRACT FROM AUTHOR]

The residual sand (D > 62.5 μm) transport (RST) refers to the tidally averaged rate of horizontal sand transport. Albeit much smaller than the peak rates, it determines the morphological evolution. The analytical expression for the tide-induced RST has been reported in the condition of one-dimensional tidal currents by van de Kreeke and Robaczewska (1993). Here we extended the analytical solution to two-dimensional. The constituents of the residual, M 2 , and M 4 tidal current velocities were used to characterize the collinear tidal current in the orthogonal X and Y directions, i.e., cross-shore and alongshore, respectively, while the M 2 tidal constituent is dominant in both directions. Based on the solution, RST is controlled by a series of triple interactions of the M 2 tidal velocity in the X direction, M 2 tidal velocity in the Y direction, and the residual or M 4 velocity in the X or Y direction. The solution was applied to the tide-dominated continental shelf of the Jiangsu coast, China, where the alongshore current is much stronger than the cross-shore component. The results show that the triple interactions of the cross-shore M 2 tidal velocity (U M2), the alongshore M 2 tidal velocity (V M2), and the alongshore residual velocity account for the major parts of both the alongshore and cross-shore RST in the nearshore area. The RST patterns promote sand accumulation in the shallow nearshore area and generate a narrow and active conduit of coastal alongshore sand transport. These findings can be applied in similar marine environments to understand the effects of non-linear tidal interactions in RST. ● The mechanisms of two-dimensional tide-induced residual sand transport (RST) are revealed by the analytical solution. ● Interaction of the cross-shore M 2 , the alongshore M 2 , and the alongshore M 0 accounts for the most part of RST in the nearshore area of the Jiangsu coast, China. ● The RST patterns promote sand accumulation in the shallow nearshore area and generate a narrow and active conduit of coastal alongshore sand transport. [ABSTRACT FROM AUTHOR]

Introduction: Non-pharmacological interventions play a crucial role in the management of non-specific chronic low back pain (NSCLBP). One prime example is Tuina, a traditional Chinese manual therapy that incorporates pressing, kneading and rubbing techniques to alleviate physical discomfort and enhance overall well-being. It serves as a widely used technique in China and other East Asian countries. However, the effectiveness and safety of Tuina for managing NSCLBP have not been substantiated through rigorous clinical research. We sought to carry out a randomised controlled trial with an open-label design, blinded assessors and parallel arms to assess the effectiveness and safety of Tuina as a treatment for NSCLBP. The trial aims to provide high-quality evidence regarding the efficacy and safety of Tuina in improving outcomes for patients with NSCLBP., Methods and Analysis: A total of 150 patients aged 18-60 years with NSCLBP will be recruited. Participants will be randomly assigned to one of the two groups. Both groups will receive standard health education. In addition, the treatment group will receive Tuina therapy, while the control group will participate in core stability exercises. Each group will undergo a total of 18 interventions over 6 weeks, with the interventions administered three times per week. The primary outcome measure is the patient's pain intensity, assessed using the Numerical Rating Scale, at week 6 following randomisation. Secondary outcomes encompass disability (measured by the Roland-Morris Disability Questionnaire), quality of life (assessed using the EuroQoL-5 dimensions questionnaire), adverse emotions (evaluated with the Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia and Depression Anxiety Stress Scale), biomechanical outcomes, socioeconomic indicators (medication use, healthcare utilisation and absenteeism), patient satisfaction, treatment adherence and other relevant factors.The statistical analysis will follow the intention-to-treat principle. Two-way repeated measures analysis of variance will be used to compare the clinical data across different time points within both groups., Ethics and Dissemination: The study protocol has received approval from the Ethics Committee of Shuguang Hospital, Shanghai University of Traditional Chinese Medicine (2023-1366-133-01). All study participants will be required to give written informed consent. The findings of the study will be submitted to a peer-reviewed journal for publication and presented at scientific conferences. Additionally, the participants will receive copies of the results., Trial Registration Number: ChiCTR2300076257., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Low back pain is a common reason for medical care and carries a heavy social burden. The efficacy of Tuina or health care education for low back pain has been evaluated in previous systematic reviews. However, there is no evidence to support the superiority of one form of treatment over another. The aim of this study is to compare the efficacy of Tuina with health care education in the management of low back pain., Methods/design: This study is a randomized controlled trial with parallel-group design including two groups: a Tuina group and a health care education group. A total of 160 eligible participants will be randomly assigned to the groups in a 1:1 ratio. The interventions of both groups will last for 20 min and be carried out twice each week for a period of 12 weeks. The primary outcome is the Oswestry Disability Index. The secondary outcomes include a visual analogue scale and the 36-item Short Form Health Survey. They will be assessed at baseline, at the end of the intervention every month, and during 6 months and 9 months of follow-up by repeated measures analysis of variance. The significance level is 5%. The safety of Tuina and health care education will be evaluated after each treatment session. This study will focus on the value of Tuina and health care education for low back pain and will highlight any differences in the efficacy of the treatments., Discussion: This study will evaluate the efficacy and safety of Tuina intervention for low back pain, which could provide reliable evidence for clinical decision making for patients with low back pain., Trial Registration: Chinese Clinical Trial Registry, ChiCTR1900022656. Registered on 23 April 2019.

Background: Chronic neck pain (CNP) is a common and disabling musculoskeletal disorder in developing and developed countries. Previous studies have shown that tuina and traditional Chinese massage are effective treatments for patients with CNP. However, there is little evidence to support the use of one intervention over the other. The aim of this study is to compare the effects of tuina and traditional Chinese massage in the treatment of pain and disability in patients with CNP., Methods/design: This is a multicenter, assessor- and analyst-blinded, randomized controlled trial with two parallel arms: a tuina group and a traditional Chinese massage group. A total of 356 eligible CNP patients will be randomly assigned to the groups in a 1:1 ratio. The intervention in the tuina group includes both structural and relaxation massage, while the traditional Chinese massage group will receive relaxation massage only. The interventions for both groups will last for 15 min and will be carried out three times a week for a period of 4 weeks. The primary outcome will be changes in the Northwick Park Neck Pain Questionnaire. Secondary outcomes will be measured by a visual analogue scale (VAS), the Neck Disability Index (NDI), and the 36-item Short-Form Health Survey (SF-36). The data will be analyzed at the baseline, at the end of the intervention, and during the 3 months of follow-up by repeated measures analysis of variance. The significance level is 5%. The safety of tuina and traditional Chinese massage will be evaluated after each treatment session. The results of this trial will help clarify the value of tuina and traditional Chinese massage as treatments for CNP and will highlight any differences in the efficacy of the treatments., Discussion: The purpose of this trial is to determine whether tuina is more effective than traditional Chinese massage in adults with CNP. This trial will, therefore, contribute to providing a solid foundation for clinical treatment of CNP, as well as future research in massage therapy., Trial Registration: Chinese Clinical Trial Registry, ChiCTR-INR-17013763 . Registered 8 December 2017.