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Purpose: With the increasing use of stereotactic body radiation therapy (SBRT) for primary and metastatic cancer, use of multitarget thoracic (MTT) SBRT is rising. Given the limited safety and efficacy data, we report the experience of this strategy from a large academic center., Methods and Materials: Between 2012 and 2021, patients who received SBRT for ≥2 thoracic targets separated by ≤1 year were retrospectively reviewed. The primary endpoint was clinically significant radiation pneumonitis (CSRP) requiring steroids, oxygen, or intubation. Secondary endpoints included local failure (LF), initiation or change of systemic therapy (ICST), progression-free survival, and overall survival. Competing risk analysis was used to evaluate the cumulative incidence of CSRP, LF, and ICST. Univariate and multivariable analyses were performed to look for clinical and dosimetric predictive factors of CSRP and LF., Results: One hundred ninety patients (481 lesions) were treated with MTT SBRT with a median follow-up of 19.7 months. Indications for SBRT were oligometastases (n = 70; 36.8%), oligoprogression (n = 62; 32.6%), curative intent in patients with primary lung cancer (n = 37; 19.5%), and control of dominant areas of metastatic progression (n = 21; 11.0%). The number of irradiated tumors ranged from 2 to 7 and the majority of SBRT courses were delivered simultaneously (88.2%). Overall, 14 patients (7.4%) had CSRP, with 5 cases requiring oxygen. The cumulative incidence of CSRP at 6 and 12 months was 5.3% and 7.6%, respectively. The cumulative incidence of LF at 2 years was 10.5%. The cumulative incidence of ICST at 2 years was 41.1%. Median progression-free survival was 11.8 months and median overall survival was 51.3 months. On multivariable analysis, a higher lung V35 Gy (hazard ratio, 2.59; P = .02) was a statistically significant predictor of CSRP and colorectal histology predicted for higher LF (hazard ratio, 2.12; P = .02)., Conclusions: In one of the largest institutional series of MTT SBRT, rates of CSRP and LF were low. Optimizing plans to lower the lung V35 Gy may decrease the risk of CSRP., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: This study aimed to characterize contemporary management of Canadian patients with cardiovascular implantable electronic devices (CIEDs) undergoing radiation therapy (RT) in light of updated American Association of Physicists in Medicine guidelines., Methods and Materials: A 22-question web-based survey was distributed to members of the Canadian Association of Radiation Oncology, Canadian Organization of Medical Physicists, and Canadian Association of Medical Radiation Technologists from January to February 2020. Respondent demographics, knowledge, and management practices were elicited. Statistical comparisons by respondent demographics were performed using χ 2 and Fisher exact tests., Results: In total, 155 surveys were completed by 54 radiation oncologists, 26 medical physicists, and 75 radiation therapists in academic (51%) and community (49%) practices across all provinces. The majority of respondents (77%) had managed >10 patients with CIEDs in their career. Most respondents (70%) reported using risk-stratified institutional management protocols. Respondents used manufacturer recommendations, rather than American Association of Physicists in Medicine or institutionally recommended dose limits, when the manufacturer limit was 0 Gy (44%), 0 to 2 Gy (45%), or >2 Gy (34%). The majority of respondents (86%) reported institutional policies to refer to a cardiologist for CIED evaluation both before and after completion of RT. Cumulative dose to CIED, pacing dependence, and neutron production were considered during risk stratification by 86%, 74%, and 50% of participants, respectively. Dose and energy thresholds for high-risk management were not known by 45% and 52% of respondents, with radiation oncologists and radiation therapists significantly less likely to report thresholds than medical physicists ( P < .001). Although 59% of respondents felt comfortable managing patients with CIEDs, community respondents were less likely to feel comfortable than academic respondents ( P  = .037)., Conclusions: The management of Canadian patients with CIEDs undergoing RT is characterized by variability and uncertainty. National consensus guidelines may have a role in improving provider knowledge and confidence in caring for this growing population., (© 2023 The Author(s).)

Purpose: The purpose of this study was to quantitatively assess the CT metal-induced artifacts from a novel direction-modulated brachytherapy (DMBT) tandem applicator prototype, recently designed for cervical cancer treatments., Methods and Materials: A water-based pelvic phantom was constructed for CT scanning. The DMBT applicator was imaged using our institutional protocol, one with higher kVp and mAs settings, and repetition of these protocols using 3-mm slices. A conventional stainless steel applicator was also scanned. In addition to the standard reconstructed images, applicator images were reconstructed using a commercial metal artifact-reduction (MAR) algorithm and an in-house-developed research algorithm. Subsequently, image quality and artifact severity were evaluated., Results: Artifact severity, measured in terms of SDs in CT numbers, decreased asymptotically to background water levels with the distance away from the applicator. Artifact-reduction algorithms lead to significant and visible improvements in image quality, with >50% and >20% decrease in artifact severity achieved at a 10-mm distance for the DMBT and stainless steel applicators, respectively. Differences in artifact severity were minimal between the four imaging protocols. DMBT dimensions were the same on images with and without the commercial MAR algorithm, within <1 mm of the theoretical value. Both the commercial and in-house algorithms restored the CT numbers outside the applicator, albeit a better performance was achieved by the in-house algorithm., Conclusions: The artifacts produced by both applicators were minimized with the use of MAR algorithms. Adoption of the DMBT and stainless steel applicators for CT-guided brachytherapy is anticipated as MAR algorithms are widely available on CT scanners., (Copyright © 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)

Objectives: Numerous neuroimaging techniques have been recently used to investigate central mechanisms involved in pain perception and to examine morphological and functional brain alterations associated with chronic pain. Compared to self-reporting approaches, objective imaging techniques are expected to potentially lead to better pain assessment and guide management. This comprehensive scoping review aims to identify recent magnetic resonance imaging (MRI) approaches that have been used to characterize the brain of chronic pain subjects, using structural, chemical and functional MRI techniques., Methods: A systematic search and review of the literature was conducted and the resultant studies were critically examined for relevance., Results: MRI neuroimaging of various chronic pain conditions were summarized. We classified the collected studies into: structural brain alterations, VBM (voxel based morphology) examination of structural changes, DTI, changes in brain chemistry, functional and blood flow brain alterations., Discussion: From our clinical experience, we have noted that most clinicians are not aware of the capabilities of advanced MRI methods in assessing cortical manifestations of chronic pain. In addition, many clinicians are not aware of the cortical alterations present in individuals with chronic pain. This comprehensive scoping review thus sets out to first summarize MRI neuroimaging techniques that are available in the current literature to examine chronic pain. We then identify cortical MR approaches that have been able to reliably predict transition from acute to chronic pain. Finally, we summarize MRI neuroimaging techniques that have been used to track treatment response of individuals with chronic pain.

Myofascial pain syndrome is a common musculoskeletal pain disorder characterized by the presence of myofascial trigger points (MTrPs). The diagnosis of myofascial pain syndrome is currently made on clinical grounds. Numerous diagnostic criteria are used to identify myofascial pain syndrome, including the localization of MTrPs. Identifying the presence of MTrPs currently requires the physician to palpate the symptomatic region. Because the interrater reliability of the palpation technique has been found to be poor, numerous groups have been interested in finding objective imaging measures to localize the MTrP. This comprehensive review focuses on summarizing ultrasound imaging techniques that have shown promise in visually localizing the trigger point. The authors' literature search identified three sonographic approaches that have been used in MTrP localization: conventional gray-scale imaging, Doppler imaging, and elastographic ultrasound imaging. This review article explains the basic physics behind the imaging methods and summarizes the characteristics of the MTrP as identified by the ultrasonic techniques.

Object: There have been no studies to investigate the effects of cycling exercise protocols, as well as repeated bouts of exercise, on the blood oxygen level-dependent (BOLD) response in the quadriceps muscles. This study characterized BOLD signal recovery following non-ischemic bouts of exercise in the quadriceps muscles of healthy adults in order to provide a basis for application of a protocol for clinical populations., Materials and Methods: Healthy male subjects (23.7 ± 2.0 years of age, n = 10) completed three cycles of one-minute exercise (65 % of maximum workload), with two minutes of rest between each bout, on an MRI-compatible ergometer. The BOLD responses during recovery were fitted to a sigmoid model, and response kinetics (post-exercise intensity [S0]), response time (α), change in baseline BOLD signal (κ), and inflection point (β)] were measured., Results: The sigmoid function fit well to the post-exercise BOLD data (r (2) = 0.95 ± 0.04). The mean response time was 10.5 ± 3.8 seconds, change in baseline BOLD intensity was 0.15 ± 0.068, and time to half-peak was 20.2 ± 8.6 seconds., Conclusion: The proposed sigmoid model is a robust method for quantifying quadriceps BOLD response post-exercise without induced ischemia. Extension of this model to evaluate microvascular responses in patients with chronic disease could improve our understanding of exercise intolerance.

Background: Exercise intolerance is prevalent in individuals with Turner Syndrome (TS). We recently demonstrated that girls with TS have normal aerobic but altered skeletal muscle anaerobic metabolism compared to healthy controls (HC). The purpose of this study was to compare peripheral skeletal muscle microvascular function in girls with TS to HC after exercise. We hypothesized that girls with TS would have similar muscle blood-oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) signal responses during recovery from exercise compared to HC., Methods: Thirteen TS participants and 8 HC completed testing. BOLD MRI was used to measure skeletal muscle microvascular response during 60 second recovery, following 60 s of exercise at 65% of maximal workload. Exercise and recovery were repeated four times, and the BOLD signal time course was fit to a four-parameter sigmoid function., Results: Participants were 13.7 ± 3.1 years old and weighed 47.9 ± 14.6 kg. The mean change in BOLD signal intensity following exercise at the end of recovery, the mean response time of the function/the washout of deoxyhemoglobin, and the mean half-time of recovery were similar between the TS and HC groups., Conclusions: Our results demonstrate that compared to HC, peripheral skeletal muscle microvascular function following exercise in girls with TS is not impaired., General Significance: This study supports the idea that the aerobic energy pathway is not impaired in children with TS in response to submaximal exercise. Other mechanisms are likely responsible for exercise intolerance in TS; this needs to be further investigated.

Object: To investigate whether postural change from erect to recumbent position affects calf muscle water diffusivity., Materials and Methods: Ten healthy adults (27.2 ± 4.9 years, 3 females) were imaged at baseline (following assumption of recumbent position), and after 34 min (session 2) and 64 min (session 3) of laying supine within a 3T MRI scanner. Diffusion tensor imaging (DTI) eigenvalues, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were evaluated in five calf muscles (anterior and posterior tibialis and triceps surae) during each of the three imaging sessions., Results: Significant decreases were observed in all of the eigenvalues and ADC in each of the muscles with postural change. These reductions ranged from 3.2 to 6.7% and 3.4 to 7.5% for the various DTI metrics, following 34 and 64 min of supine rest, respectively (P < 0.05). No significant differences were noted in ADC or eigenvalues between the second and third imaging sessions for any muscle. FA did not change significantly with postural manipulation in any muscle compartment., Conclusion: Diffusion tensor imaging indices were altered with postural change. As differences were not apparent between the latter two imaging sessions, we suggest that a short supine resting period (~34 min) is sufficient for muscle diffusivity to stabilize prior to quantitative MR imaging in healthy young adults.

Objective: The objective of this study was to establish normative diffusion tensor imaging (DTI) eigenvalues (λ1,λ2,λ3), apparent diffusion coefficient, and fractional anisotropy in asymptomatic foot muscles., Methods: Ten healthy adults (mean [SD], 25.9 [4.3] years) were examined using a 3-T magnetic resonance imaging scanner. Diffusion tensor imaging indices were evaluated in 5 muscles in the foot: quadratus plantae, abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, and abductor digiti minimi. Signal-to-noise ratio was also measured for each muscle., Results: In the various foot muscles, λ1 ranged from 1.88 × 10 to 2.14 × 10 mm/s, λ2 ranged from 1.39 × 10 to 1.48 × 10 mm/s, and λ3 ranged from 0.91 × 10 to 1.27 × 10 mm/s; apparent diffusion coefficient ranged from 1.48 × 10 to 1.55 × 10 mm/s; and fractional anisotropy ranged from 0.21 to 0.40. Statistical differences were seen in some eigenvalues between muscle pairs. Mean signal-to-noise ranged from 47.5 to 69.1 in the various muscles examined., Conclusions: Assessment of anisotropy of water diffusion in foot muscles was feasible using DTI. The measured DTI metrics in the foot were similar to those in calf and thigh skeletal muscles.

Diagnostic imaging procedures for muscle evaluation have typically provided basic information concerning gross anatomical change resulting from pathology. Up until recently the musculoskeletal radiologist has been fairly limited to using simple proton-density weighted fat-saturated and short tau inversion recovery magnetic resonance imaging scans for assessment of skeletal muscle. Recent advances, however, have resulted in development of newer scans and postprocessing methods that provide much more than gross muscle structure. Scans providing fine structure, muscle function, and metabolism can easily be done using clinical scanners. Here we describe how diffusion tensor imaging (DTI) and blood oxygenation level-dependent (BOLD) imaging together can provide detailed information on muscle structural and functional changes. DTI is useful for visualizing muscle tears, and BOLD can be used for vascular insufficiency (e.g., compartment syndrome). In clinical sites that are gaining experience using these techniques, imaging of muscle pathology is becoming increasingly thorough. In the future, these methods will reduce the need for invasive approaches to study muscle pathology.

Introduction: The utilization of metal shields in intensity-modulated brachytherapy (IMBT) enables the modulation of the dose, resulting in improved conformance to the tumor while simultaneously reducing the doses to organs at risk (OARs). Utilizing higher-energy sources like 60Co in IMBT for cervical and vaginal cancers has consistently posed challenges. This study evaluates the dosimetric aspects of modified applicators designed for IMBT using 60Co and 192Ir sources. Materials and Methods: GATE, a Geant4-based simulation code, was utilized to model and simulate four distinct applicators. The clinical applicators were redesigned to place the structure of the source tube and the shield while keeping the general characteristics unchanged. These shields were evaluated by calculating transmission factors (TFs) and the dose homogeneities were also determined. Result: Transmission factors for the IMBT technique in redesigned intrauterine applicators and tungsten shields for iridium and cobalt sources were at least 12.8 and 65.4%, and these values were obtained for the intravaginal applicator at 0.2 and 7.0%, respectively. The dose homogeneities for all combinations of radionuclide-shield were within a 15% range of the non-IMBT applicators. Conclusion: This study has quantitatively evaluated the dosimetric effect of tungsten shields in the IMBT technique for cervical and vaginal cancer using cobalt sources. 192Ir compared to 60Co resulted in higher effectiveness for the designed intrauterine and intravaginal shields. while implementing tungsten shields in the redesigned applicators against the 60Co source may not offer complete protection, it does show promising results in reducing the dose to organs at risk. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to provide measurements from and investigate the repeatability of diffusion kurtosis tensor parameters in the muscles of the lower legs., Methods: Test-retest acquisition of a kurtosis tensor sequence was performed in 13 healthy volunteers. Quantitative kurtosis tensor parameters were derived, and repeatability of each parameter was evaluated by muscle group and over the whole muscle through intraclass correlation coefficient (ICC) and within-subject coefficient of variation (wsCV). Bland-Altman analysis was also conducted. Differences in parameter values by muscle group were investigated through an analysis of variance., Results: Axial kurtosis and radial kurtosis values from the test data were 0.63 ± 0.04 and 0.70 ± 0.05, respectively. Kurtosis tensor parameters from all muscle groups and over the whole muscle had wsCV below 15%. ICC for the parameters from most muscle groups was above 85%, with the lowest ICC over the whole muscle being 88.39%. The medial gastrocnemius and extensor digitorum longus showed highest repeatability. Mean, axial, and radial diffusivity had higher wsCV despite being lower-order terms than kurtosis., Conclusion: This study sought to examine the repeatability of diffusion kurtosis tensor-derived parameters in the legs and verify that they could potentially be used as longitudinal imaging metrics. wsCV values from test-retest data indicated high repeatability throughout all examined muscle groups. There were minimal differences in kurtosis and diffusivity parameters between muscle groups in this healthy volunteer cohort., (© 2024 International Society for Magnetic Resonance in Medicine.)

Purpose: To investigate pain hypervigilance in individuals suffering from chronic neck and shoulder pain (CNSP) and its underlying brain mechanism., Methods: The evaluation of pain vigilance was conducted through the utilization of pain vigilance and awareness questionnaires. Voxel-wise regional homogeneity (ReHo) from 60 CNSP patients and 60 healthy controls (HCs) using resting-state fMRI data. Voxel-wise two-sample T-test was conducted to reveal the ReHo variations between CNSP and HC. Correlation analyses were utilized to reveal the connection between brain abnormalities and medical measurements. Furthermore, a mediation analysis was conducted to elucidate the pathway-linking changes in brain function with medical measurements., Results: Our present study revealed three main findings. Firstly, patients with CSNP demonstrated a heightened vigilance of pain in comparison to healthy adults, a common occurrence among individuals with chronic pain conditions. Secondly, we observed brain abnormalities in various brain regions in CSNP patients, and these alterations were associated with the extent of pain vigilance. Lastly, the pain hypervigilance impact on the severity of pain was found to be controlled by regional neural activity in the anterior cingulate cortex (ACC) in subjects with CSNP., Conclusion: Our findings suggested that long-term repetitive nociceptive input caused by chronic pain further aggravates the pain intensity by impairing the vigilance-related pain processing within the anterior cingulate cortex in CNSP patients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective Myofascial pain syndrome (MPS) is a clinical disorder with a prevalence of 85%. It is characterized by the presence of trigger points, and all people experience it at least once in their lives. Different physiotherapy and medical methods are used to manage MPS. Intramuscular electrical stimulation (IMES) is a relatively new treatment option for MPS. This study aims to examine the effect of IMES on clinical and ultrasound imaging parameters related to trigger points in patients with MPS. Materials & Methods This is a case series clinical trial. Twelve participants with trigger points in their upper trapezius muscles participated in this study. They were treated three times per week with IMES. Before and after the intervention, pain and cervical spine range of motion (ROM) were measured with the visual analog scale and goniometry. Ultrasonic parameters (longitudinal diameter and the area of trigger points, and the thickness of the upper trapezius muscle) were assessed with B-mode ultrasound imaging technique. The pre-test and post-test values were compared using the paired t-test. The significance level was set at 0.05. Results After three sessions of IMES, pain and cervical spine ROM improved significantly (P<0.05). All ultrasound imaging parameters, including trigger points' longitudinal diameter and area and upper trapezius muscle thickness, decreased significantly compared to baseline (P<0.05). Conclusion IMES seems to have promising effects on clinical and ultrasound imaging parameters of patients with MPS. Further studies with larger sample sizes are recommended to investigate the longterm effects of IMES with the inclusion of a matched control group. [ABSTRACT FROM AUTHOR]

Background: Ultrasonographic evaluation of trigger points detected by physical examination in patients with myofascial pain syndrome is being used more frequently in clinical care. However, the sonographic appearance of trigger points, in association with pain and disability, has not been adequately described. Objective: To reveal the presence of trigger points with ultrasonography in those with myofascial pain syndrome and to determine if ultrasound images can help discriminate between demographic and disease characteristics. Methods: Fifty‐two participants with chronic neck pain (NP) were in this cross‐sectional study. The pain intensity was evaluated using a 0–10 cm visual analog scale (VAS). The neck disability index measured the NP‐induced disability status of the participants. Ultrasonography was used to measure the thicknesses of the paraspinal muscles and the presence of hypoechoic areas within these muscles. Results: There was a positive correlation between the VAS scores of the participants and the ultrasonographic detection of myofascial trigger points (MTPs) in the multifidus and middle trapezius muscles (right/left r =.30, p =.027; r =.29, p =.029; r =.32, p =.009, r =.30, p =.011, respectively). These features correlated with the disability levels of the participants and the MTPs on both the right and left sides of the splenius, multifidus, upper trapezius, and middle trapezius (r =.32, p =.028; r =.38, p =.013, r =.25, p =.027; r =.33, p =.016; r =.25, p =.025, r =.32, p =.018, r =.28, p =.013, r =.29, p =.016, respectively). A significant correlation was present between the detection of MTP at ultrasonography and decreased muscle thickness in the relevant muscles (between p =.001 and p =.034). Conclusion: The detection of MTPs with ultrasonography is associated with the severity of pain and disability in those with chronic NP. Features on ultrasound include hypoechoic changes within muscle and reduced muscle thickness associated with MTPs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recent evidence has suggested that reversal of gray or white matter abnormalities could be a criterion of recovery in patients with chronic pain. OBJECTIVE: To determine the effectiveness of exercise-based interventions in reversing gray and white matter abnormalities in patients with chronic musculoskeletal pain. METHODS: An electronic search was performed in the MEDLINE (Via PubMed), EMBASE, Web of Science, LILACS, SPORTDiscus, CINAHL, PEDro, and CENTRAL databases. Randomized clinical trials (RCTs) including patients with chronic musculoskeletal pain, which assessed the change in gray and white matter abnormalities after exercise-based interventions were selected. The risk of bias was assessed using the Risk of Bias II tool. RESULTS: Four RCTs were included (n = 386). Three studies showed reversal of abnormalities with exercise-based interventions compared to control groups. The reversal was observed in the gray matter volume in the medial orbital prefrontal cortex and in the supplementary motor area of patients with osteoarthritis, in the hippocampus, insula, amygdala and thalamus in fibromyalgia patients. Furthermore, in patients with chronic spinal pain, reversal was observed in the gray matter thickness of the frontal middle caudal cortex and in the caudate, putamen and thalamus gray matter volume. CONCLUSIONS: There is insufficient evidence to determine the effectiveness of exercise-based interventions for reversing gray and white matter abnormalities in patients with chronic pain. Further studies are still needed in this field. [ABSTRACT FROM AUTHOR]

Objectives: Patients frequently present to the emergency department (ED) with neck or back pain, which can be difficult to treat. We sought to compare ultrasound‐guided trigger point injection (TPI) to standard medications for patients with neck or back pain. Methods: We performed a single‐center, open label, randomized controlled trial on ED patients with neck or back pain from myofascial pain syndrome comparing ultrasound‐guided TPIs to those who received the combination of a nonsteroidal anti‐inflammatory drug (NSAID) and a muscle relaxant (MR). The primary outcome of this study was the reduction in mean pain score at the time of ED disposition. Results: In total, we analyzed 196 patients. At the time of ED disposition, patients in the TPI group had a mean reduction in their pain scores of 45.0 mm as compared to 49.9 mm in the NSAID plus MR group (difference: 4.9 [95% confidence interval (CI) −3.0 to 12.7], P =.22). At the first reassessment, patients in the TPI group had greater pain reduction by 10.7 mm (95% CI 3.1 to 18.4). The rate of rescue therapy use was higher in the NSAID plus MR group (difference: 17.5% [95% CI 4.4 to 36.2]). Conclusions: We found no difference in pain reduction at the time of ED disposition between patients randomized to the ultrasound‐guided TPI group as compared to those who received an NSAID plus a MR. However, patients in the TPI group had greater pain reduction at the time of first reassessment and lower rates of rescue therapy use. [ABSTRACT FROM AUTHOR]

The article discusses the use of ultrasonography in diagnosing myofascial pain syndrome (MPS) and locating myofascial trigger points (MTrPs) in patients with chronic musculoskeletal pain. The authors highlight the potential of ultrasound imaging techniques, such as grayscale, Doppler, and elastographic ultrasound, in accurately identifying MTrPs. They emphasize the importance of US guidance in detecting local twitch responses in deep muscles, which are crucial for confirming the diagnosis of MPS. The authors suggest that further research in this area could lead to valuable insights and advancements in the field. [Extracted from the article]

We aimed to detect physiologic changes of leg muscle signal on magnetic resonance (MR) diffusion-weighted imaging (DWI) in asymptomatic subjects after repetitive plantar flexion exercises. In this monocentric prospective study, DWI of both legs were performed at rest and after exercise periods (5 min, Ex5: and 10 min, Ex10) in 20 active healthy subjects (mean age 31 years). The exercise consisted in repetitive plantar flexion of the right foot using elastic band, the patient being sited directly on the MR table. Both visual semiquantitative evaluations and quantitative (apparent diffusion coefficient, ADC; fractional anisotropy, FA) were performed in 5 leg compartments. Visually, signal changes involved mainly the fibular and gastrocnemius muscles and were considered intense after Ex5 in 3 subjects, moderate only after Ex5 in 10, and moderate only after Ex10 in 4. No changes were visible in 3 subjects. Quantitative evaluation confirmed significant signal changes in the fibular (ADC: + 17.4%, p < 0.001; FA: -8.3%, p = 0.030) and gastrocnemius (ADC: + 13.7%, p < 0.001; FA: -11.4%, p < 0.001) muscles between rest and post-exercise MR. Plantar flexion exercises induce changes on DWI, especially in fibular and gastrocnemius muscles, which can be visually and quantitatively detectable in asymptomatic active subjects. Trial registration EudraCT 2008-A00694-51. [ABSTRACT FROM AUTHOR]

Introduction. Musculoskeletal pain (MSP) is a frequent reason for consultation; its high prevalence is a concern. Recently, different electrolysis modalities have appeared to reduce MSP, although studies supporting their use and comparing them are limited. This study compared the effectiveness of electrolysis modalities in MSP treatment. Methods. The PubMed, Scopus, Web of Science, CINAHL, and ScienceDirect electronic databases were searched for randomized clinical trials (RCTs) (last update: September 4, 2020). Three independent researchers reviewed titles and abstracts to determine article eligibility. Risk of bias and quality were assessed with the Cochrane risk of bias tool and the PEDro scale. Pain reduction was the main outcome and changes in range of motion or disability/functionality constituted secondary results. Results. Overall, 15 RCTs were obtained after eliminating duplicates and applying the selection criteria. Musculoskeletal conditions treated with electrolysis or microelectrolysis included myofascial pain (n = 3), patellar tendinopathy (n = 2), plantar fasciitis (n = 2), pubalgia (n = 1), subacromial impingement (n = 3), epicondylitis (n = 1), calcaneal tendinopathy (n = 2), and whiplash syndrome (n = 1). The studies had a low risk of bias and an average PEDro score of 9. They revealed pain reduction for electrolysis and microelectrolysis at the end of treatment and follow-up evaluations (p < 0.005), and functionality improvement for all experimental groups (p < 0.005). Conclusions. Electrolysis and microelectrolysis treatments reduce pain and improve functionality in MSP conditions. Although both techniques are effective, comparative studies are suggested to determine therapeutic differences and user preferences. [ABSTRACT FROM AUTHOR]

Chronic pain represents one of the most serious worldwide medical problems, in terms of both social and economic costs, often causing severe and intractable physical and psychological suffering. The lack of biological markers for pain, which could assist in forming clearer diagnoses and prognoses, makes chronic pain therapy particularly arduous and sometimes harmful. Opioids are used worldwide to treat chronic pain conditions, but there is still an ambiguous and inadequate understanding about their therapeutic use, mostly because of their dual effect in acutely reducing pain and inducing, at the same time, tolerance, dependence, and a risk for opioid use disorder. In addition, clinical studies suggest that opioid treatment can be associated with a high risk of immune suppression and the development of inflammatory events, worsening the chronic pain status itself. While opioid peptides and receptors are expressed in both central and peripheral nervous cells, immune cells, and tissues, the role of opioids and their receptors, when and why they are activated endogenously and what their exact role is in chronic pain pathways is still poorly understood. Thus, in this review we aim to highlight the interplay between pain and immune system, focusing on opioids and their receptors. [ABSTRACT FROM AUTHOR]

Objective: Myofascial trigger points (MTrPs) are pathognomonic of myofascial pain syndrome. The detection ability of MTrPs via ultrasonography is underreported and the characteristics of MTrPs are not sufficiently standardized. The objective was to summarize the characteristics and diagnostic abilities of ultrasonography for MTrP investigations. Materials and Methods: A multi-database, and bibliography hand-search was implemented. Studies of ≥10 patients, published after 1980, appraising ultrasonography as a diagnostic aid for myofascial pain syndrome were included. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to evaluate the diagnostic accuracy of the included studies. Results: Six cross-sectional studies met the inclusion criteria. The back and trapezius muscles were the most studied locations. The diagnostic studies were of low-medium risk of bias. The studies reported a large range of diagnostic metrics (accuracy 58%–100%, sensitivity 33%–91%, specificity 75%–100%, positive predictive value 91%–100%, negative predictive value 47%–97%, positive likelihood ratio 3.6, and negative likelihood ratio 0.12–0.67). Conclusion: This review found low-medium risk of bias evidence in support of ultrasonography for MTrP investigations. The clinical studies identified in the scoping review used gray-scale ultrasound equipment systems with a 5 to 14 MHz transducer to diagnose MTrPs and the local twitch response, and MTrPs were visualized mostly as hypoechoic nodules. [ABSTRACT FROM AUTHOR]

Objective: Acupuncture has been shown to be effective in the treatment of chronic pain. However, their neural mechanism underlying the effective acupuncture response to chronic pain is still unclear. We investigated whether metabolic patterns in the pain matrix network might predict acupuncture therapy responses in patients with primary dysmenorrhea (PDM) using a machine-learning-based multivariate pattern analysis (MVPA) on positron emission tomography data (PET). Methods: Forty-two patients with PDM were selected and randomized into two groups: real acupuncture and sham acupuncture (three menstrual cycles). Brain metabolic data from the three special brain networks (the sensorimotor network (SMN), default mode network (DMN), and salience network (SN)) were extracted at the individual level by using PETSurfer in fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET) data. MVPA analysis based on metabolic network features was employed to predict the pain relief after treatment in the pooled group and real acupuncture treatment, separately. Results: Paired t -tests revealed significant alterations in pain intensity after real but not sham acupuncture treatment. Traditional mass-univariate correlations between brain metabolic and alterations in pain intensity were not significant. The MVPA results showed that the brain metabolic pattern in the DMN and SMN did predict the pain relief in the pooled group of patients with PDM (R 2 = 0.25, p = 0.005). In addition, the metabolic pattern in the DMN could predict the pain relief after treatment in the real acupuncture treatment group (R 2 = 0.40, p = 0.01). Conclusion: This study indicates that the individual-level metabolic patterns in DMN is associated with real acupuncture treatment response in chronic pain. The present findings advanced the knowledge of the brain mechanism of the acupuncture treatment in chronic pain. [ABSTRACT FROM AUTHOR]

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Background: Ultrasonographic evaluation of trigger points detected by physical examination in patients with myofascial pain syndrome is being used more frequently in clinical care. However, the sonographic appearance of trigger points, in association with pain and disability, has not been adequately described., Objective: To reveal the presence of trigger points with ultrasonography in those with myofascial pain syndrome and to determine if ultrasound images can help discriminate between demographic and disease characteristics., Methods: Fifty-two participants with chronic neck pain (NP) were in this cross-sectional study. The pain intensity was evaluated using a 0-10 cm visual analog scale (VAS). The neck disability index measured the NP-induced disability status of the participants. Ultrasonography was used to measure the thicknesses of the paraspinal muscles and the presence of hypoechoic areas within these muscles., Results: There was a positive correlation between the VAS scores of the participants and the ultrasonographic detection of myofascial trigger points (MTPs) in the multifidus and middle trapezius muscles (right/left r = .30, p = .027; r = .29, p = .029; r = .32, p = .009, r = .30, p = .011, respectively). These features correlated with the disability levels of the participants and the MTPs on both the right and left sides of the splenius, multifidus, upper trapezius, and middle trapezius (r = .32, p = .028; r = .38, p = .013, r = .25, p = .027; r = .33, p = .016; r = .25, p = .025, r = .32, p = .018, r = .28, p = .013, r = .29, p = .016, respectively). A significant correlation was present between the detection of MTP at ultrasonography and decreased muscle thickness in the relevant muscles (between p = .001 and p = .034)., Conclusion: The detection of MTPs with ultrasonography is associated with the severity of pain and disability in those with chronic NP. Features on ultrasound include hypoechoic changes within muscle and reduced muscle thickness associated with MTPs., (© 2023 American Academy of Physical Medicine and Rehabilitation.)

Background: Due to the special anatomy of the lower leg, tibial diaphyseal fracture causes increased intracompartmental pressure (ICP). Not only is this increased ICP the manifestation of skeletal muscle injury, but it induces further deterioration of the injury. The aim of this study was to assess the association between short-term ICP elevation and long-term skeletal muscle recovery after severe limb trauma.Methods: In this single-center ambispective cohort study, we retrospectively screened and recruited a cohort of tibial diaphyseal fracture patients with integrated ICP data during the early post-traumatic period, and performed a prospective observational study to evaluate their skeletal muscle recovery through long-term follow-up and MR imaging after the removal of the implants. We analyzed the association between ICP elevation and skeletal muscle recovery using statistical methods.Results: A total of 46 patients with healed fractures underwent intramedullary nail removal and MR imaging. The absolute values of the Pearson product-moment correlation coefficients between various ICP parameters and the cross-sectional area ratio (CSAR) ranged from 0.588 to 0.793, and the correlation coefficients between the ICP parameters and the average T2-weighted signal intensity ratio (T2SIR) varied from 0.566 to 0.775. Statistically significant associations were observed between the ICP parameters and the MR imaging parameters when simple linear regression analysis was performed. Among the ICP parameters, the accumulated ΔP (ΔP = diastolic blood pressure minus ICP) had the highest determination coefficient and explained 62.1% and 59.1% of the variance in CSAR and T2SIR, respectively.Conclusions: Short-term ICP elevation was associated with long-term skeletal muscle recovery following tibial diaphyseal fracture, especially for ICP data that integrated time factors.Level Of Evidence: Level 3. [ABSTRACT FROM AUTHOR]

The most common cause of chronic musculoskeletal pain is chronic myofascial pain syndrome (MPS). MPS often presents with increased muscle stiffness, and the myofascial trigger point (MTrP). Imaging modalities have been used to identify the MTrP, but their role in the detection and diagnosis of MPS remains unclear. The purpose of this review was to identify evidence in literature for the use of imaging in the role of classifying and explaining the physiology of MTrPs. Since few imaging techniques have been performed on MTrPs, we explored the imaging techniques that can effectively image complex skeletal muscle microstructure, and how they could be used. As part of a scoping review, we conducted a systematic search from three medical databases (CINAHL, EMBASE and MEDLINE) from year to year to analyze past MTrP imaging, as well as analyzing imaging techniques performed on the microstructure of muscle. Previously, ultrasound has been used to differentiate active, latent MTrPs, but these studies do not adequately address their underlying anatomical structure. MRI remains the standard method of imaging skeletal muscle. The existing MRI literature suggests that the DTI technique can quantify muscle injury, strain, and structure. However, theoretically, HARDI and DKI techniques seem to provide more information for complex structural areas, although these modalities have a disadvantage of longer scan times and have not been widely used on skeletal muscle. Our review suggests that DTI is the most effective imaging modality that has been used to define the microstructure of muscle and hence, could be optimal to image the MTrP. HARDI and DKI are techniques with theoretical potential for analysis of muscle, which may provide more detailed information representative of finer muscle structural features. Future research utilizing MRI techniques to image muscle are necessary to provide a more robust means of imaging skeletal muscle and the MTrP. [ABSTRACT FROM AUTHOR]

Identification of the primary source of pain determines the success of musculoskeletal pain management. A detailed history and physical examination are the current gold standards for identifying musculoskeletal pain source in day-to-day clinical practice. This process, at times, may potentially result in inadequate/inappropriate identification of the pain source. In this case report, we present the usefulness of a simple and inexpensive vacuum cup. We found that this accurately identified the primary pain source, distant from and unrelated to the site of pain presentation in a 30- year- old man with back pain. Routine use of this simple technique in conjunction with the regular musculoskeletal examination may better identify primary restrictions in the body tissues. Based on our experience, we propose that this approach has the potential to offer better outcomes in the treatment of musculoskeletal pain in the future. [ABSTRACT FROM AUTHOR]

Purpose: To present a novel, MRI‐compatible dynamicshield intensity modulated brachytherapy (IMBT) applicator and delivery system using 192Ir, 75Se, and 169Yb radioisotopes for the treatment of locally advanced cervical cancer. Needle‐free IMBT is a promising technique for improving target coverage and organs at risk (OAR) sparing. Methods and materials: The IMBT delivery system dynamically controls the rotation of a novel tungsten shield placed inside an MRI‐compatible, 6‐mm wide intrauterine tandem. Using 36 cervical cancer cases, conventional intracavitary brachytherapy (IC‐BT) and intracavitary/interstitial brachytherapy (IC/IS‐BT) (10Ci 192Ir) plans were compared to IMBT (10Ci 192Ir; 11.5Ci 75Se; 44Ci 169Yb). All plans were generated using the Geant4‐based Monte Carlo dose calculation engine, RapidBrachyMC. Treatment plans were optimized then normalized to the same high‐risk clinical target volume (HR‐CTV) D90 and the D2cc for bladder, rectum, and sigmoid in the research brachytherapy planning system, RapidBrachyMCTPS. Plans were renormalized until either of the three OAR reached dose limits to calculate the maximum achievable HR‐CTV D90 and D98. Results: Compared to IC‐BT, IMBT with either of the three radionuclides significantly improves the HR‐CTV D90 and D98 by up to 5.2% ± 0.3% (P < 0.001) and 6.7% ± 0.5% (P < 0.001), respectively, with the largest dosimetric enhancement when using 169Yb followed by 75Se and then 192Ir. Similarly, D2cc for all OAR improved with IMBT by up to 7.7% ± 0.6% (P < 0.001). For IC/IS‐BT cases, needle‐free IMBT achieved clinically acceptable plans with 169Yb‐based IMBT further improving HR‐CTV D98 by 1.5% ± 0.2% (P = 0.034) and decreasing sigmoid D2cc by 1.9% ± 0.4% (P = 0.048). Delivery times for IMBT are increased by a factor of 1.7, 3.3, and 2.3 for 192Ir, 75Se, and 169Yb, respectively, relative to conventional 192Ir BT. Conclusions: Dynamic shield IMBT provides a promising alternative to conventional IC‐ and IC/IS‐BT techniques with significant dosimetric enhancements and even greater improvements with intermediate energy radionuclides. The ability to deliver a highly conformal, OAR‐sparing dose without IS needles provides a simplified method for improving the therapeutic ratio less invasively and in a less resource intensive manner. [ABSTRACT FROM AUTHOR]

Within the brachytherapy community, many phantoms are constructed in-house, and less commercial development is observed as compared to the field of external beam. Computational or virtual phantom design has seen considerable growth; however, physical phantoms are beneficial for brachytherapy, in which quality is dependent on physical processes, such as accuracy of source placement. Focusing on the design of physical phantoms, this review paper presents a summary of brachytherapy specific phantoms in published journal articles over the last twenty years January 1, 2000 -- December 31, 2019). The papers were analyzed and tabulated by their primary clinical purpose, which was deduced from their associated publications. A substantial body of work has been published on phantom designs from the brachytherapy community, but a standardized method of reporting technical aspects of the phantoms is lacking. In-house phantom development demonstrates an increasing interest in magnetic resonance (MR) tissue mimicking materials, which is not yet reflected in commercial phantoms available for brachytherapy. The evaluation of phantom design provides insight into the way, in which brachytherapy practice has changed over time, and demonstrates the customised and broad nature of treatments offered. [ABSTRACT FROM AUTHOR]

This study explores the involvement of substance P (SP) in the parabrachial nucleus (PBN) and central amygdaloid nucleus (CeA) in the nociception–emotion link and of rats with masticatory myofascial pain (MMP) induced by chronic tetanic eccentric muscle contraction. A total of 18 rats were randomly and equally assigned for MMP (MMP group) and sham-MMP induction (sMMP group). MMP was induced by electrical-stimulated repetitive tetanic eccentric contraction of the masseter muscle for 14 consecutive days. Myofascial trigger points in the masseter muscle were identified by palpable taut bands, increased prevalence of endplate noise (EPN), focal hypoechoic nodules on ultrasound and restricted jaw opening. All animals were killed for morphological and SP immunohistochemical analyses. Chronic tetanic eccentric contraction induced significantly thicker masseter muscle confirmed by hypoechogenicity, increased prevalence and amplitudes of EPN, and limited jaw opening. Immunohistochemically, the SP-like positive neurons increased significantly in PBN and CeA of the MMP group. Our results suggested that MMP increases the SP protein levels in PBN and CeA, which play important roles in MMP-mediated chronic pain processing as well as MMP-related emotional processes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cervicogenic headache (CeH) is among the common types of headache which has an undesirable influence on the quality of life. The myofascial trigger point (MTrP) within the sternocleidomastoid (SCM) muscle is one of the most important causes of CeH. OBJECTIVE: The purpose of this study was to compare the effect of dry needling (DN) and ischemic compression (IC) on the headache symptoms as well as MTrP-related features in subjects with CeH originating from MTrPs of the SCM muscle using a sonographic method. METHODS: A total of 29 female subjects aged 35.34 ± 12.19 on average with a clinical diagnosis of CeH originating from MTrP in the SCM muscle were randomly divided into the DN, IC, and control groups. Both DN and IC groups received 4 treatment sessions. Headache intensity, duration, frequency, MTrP elastic modulus, MTrP area, and pressure pain threshold (PPT) were assessed 2 weeks before and after treatments. RESULTS: In both DN and IC groups, a significant improvement was found in the headache intensity, duration, frequency, PPT, and MTrP area (P < 0.05). No significant differences were observed between DN and IC (P > 0.05). Pearson correlation revealed a significant correlation between headache intensity and the MTrP elastic modulus (P < 0.05). CONCLUSIONS: Both interventions could reduce headache symptoms, PPT, and MTrP area. Neither intervention was found to be superior to the other in short-term follow-up. IC may be preferred since it has fewer unwanted side effects compared to DN. Based on the data, it may be concluded that some MTrP biomechanical features such as stiffness may influence the produced headache symptoms. [ABSTRACT FROM AUTHOR]

Purpose: To assess the capability of an intracavitary 169Yb‐based helical multishield rotating shield brachytherapy (RSBT) delivery system to treat cervical cancer. The proposed RSBT delivery system contains a pair of 1.25 mm thick platinum partial shields with 45° and 180° emission angles, which travel in a helical pattern within the applicator. Methods: A helically threaded tandem applicator with a 45° tandem curvature containing a helically threaded catheter was designed. A 0.6 mm diameter 169Yb source with a length of 10.5 mm was simulated. A 37‐patient treatment planning study, based on Monte Carlo dose calculations using MCNP5, was conducted with high‐risk clinical target volumes (HR‐CTVs) of 41.2–192.8 cm3 (average ± standard deviation of 79.9 ± 35.8 cm3). All patients were assumed to receive 25 fractions of 1.8 Gy of external beam radiation therapy (EBRT) before receiving 5 fractions of high‐dose‐rate brachytherapy (HDR‐BT). For each patient, 192Ir‐based intracavitary (IC) HDR‐BT, 192Ir‐based intracavitary/interstitial (IC/IS) HDR‐BT using a hybrid applicator with eight IS needles, and 169Yb‐based RSBT plans were generated. Results: For the IC, IC/IS, and RSBT treatment plans, 38%, 84%, and 86% of the plans, respectively, met the planning goal of an HR‐CTV D90 (minimum dose to hottest 90%) of 85 GyEQD2 (α/β = 10 Gy). Median (25th percentile, 75th percentile) treatment times for IC, IC/IS, and RSBT were 11.71 (6.62, 15.40) min, 68.00 (45.02, 80.02) min, and 25.30 (13.87, 35.39) min, respectively. 192Ir activities ranging from 159.1–370 GBq (4.3–10 Ci) and 169Yb activities ranging from 429.2–999 GBq (11.6–27 Ci) were used, which correspond to the same clinical ranges of dose rates at 1 cm off‐source‐axis in water. Extra needle insertion and planning time beyond that needed for intracavitary‐only approaches was accounted for in the IC/IS treatment time calculations. Conclusion: 169Yb‐based RSBT for cervical cancer met the HR‐CTV D90 goal of 85 Gy in a greater percentage of the patients considered than IC/IS (86% vs 84%, respectively) and can reduce overall treatment time relative to IC/IS. 169Yb‐based RSBT could be used to replace IC/IS in instances where IC/IS treatment is not available, especially in instances when HR‐CTV volumes are ≥30 cm3. [ABSTRACT FROM AUTHOR]

Gamma-band oscillations (GBOs) elicited by transient nociceptive stimuli are one of the most promising biomarkers of pain across species. Still, whether these GBOs reflect stimulus encoding in the primary somatosensory cortex (S1) or nocifensive behavior in the primary motor cortex (M1) is debated. Here we recorded neural activity simultaneously from the brain surface as well as at different depths of the bilateral S1/M1 in freely-moving male rats receiving nociceptive stimulation. GBOs measured from superficial layers of S1 contralateral to the stimulated paw not only had the largest magnitude, but also showed the strongest temporal and phase coupling with epidural GBOs. Also, spiking of superficial S1 interneurons had the strongest phase coherence with epidural GBOs. These results provide the first direct demonstration that scalp GBOs, one of the most promising pain biomarkers, reflect neural activity strongly coupled with the fast spiking of interneurons in the superficial layers of the S1 contralateral to the stimulated side. [ABSTRACT FROM AUTHOR]

Purpose: To identify the changes of intrinsic brain activity and regional cerebral blood flow in patients with chronic neck and shoulder pain (CNSP) by using amplitude of low-frequency fluctuation (ALFF) analysis and arterial spin labelling study. Material and methods: In total, 28 CNSP patients and 25 age-matched and sex-matched healthy controls (HCs) participated in the study. Resting-state functional magnetic resonance imaging (rs-fMRI) and arterial spin labelling (ASL) MRI were acquired. Correlations between ALFF and cerebral blood flow (CBF) were analysed. Subsequently, the differences in ALFF and CBF were compared in the two groups. Finally, the visual analogue scale (VAS) was also assessed in the CNSP group. Results: Compared with HCs, CNSP patients showed significantly abnormal ALFF and CBF in several brain regions, including the cerebellum posterior lobe, middle orbitofrontal gyrus, medial superior frontal gyrus, middle temporal gyrus, precuneus, cingulate gyrus, middle occipital gyrus, middle frontal gyrus, postcentral gyrus, precentral gyrus, and superior parietal gyrus. Correlation analysis showed that the ALFF value of the medial superior frontal gyrus positively correlated with the VAS score. However, no correlation was found between the CBF values and the VAS score. Conclusions: The altered ALFF and CBF values in CNSP patients were observed in different pain-related brain regions that were involved in pain modulation and perception. The combination of rs-fMRI and ASL MRI might provide complementary information for increasing our understanding of the neuropathology in CNSP. [ABSTRACT FROM AUTHOR]

Background: Chronic neck pain (NP) attributed to myofascial pain syndrome is one of the particularly common skeletal muscle disorder associated with the hyperirritable zone in the taut band of muscle. Trigger points (TPs) are the physical interpretation of the myofascial pain syndrome. In the United States, 30%–85% of pain patients have been affected by myofascial TPs. Objectives: To reveal preliminary evidence on the clinical efficacy of ischemic compression therapy, dry cupping, and their combination on improving the TPs' pressure pain threshold (PPT), neck range of motion (NROM), and neck disability index (NDI) in patients with TPs and nonspecific NP. Besides, assess the feasibility of conducting a randomized clinical trial (RCT). Design: A randomized pilot study was conducted on 24 patients with TPs and nonspecific NP. Patients were randomly assigned to three groups: the cupping group, the ischemic compression group, and the combination therapy group. PPT, NROM, and NDI were assessed before and after 4 weeks of treatment. Results: The results showed a statistically significant improvement in NDI, PPT, and NROM compared with values before the treatment (p < 0.05) in all groups. Although no significant difference was detected between ischemic compression (IC) and dry cupping, the combination approach showed significantly higher and faster improvement (p < 0.05). Conclusions: It is feasible to conduct a main RCT. Both IC and dry cupping may hold promise in treating TPs; a combination of the two therapies may provide superior improving rate. [ABSTRACT FROM AUTHOR]

Fear of pain (FOP) can be considered as a product of evolution from overstated negative interpretations of pain and sometimes may cause more damage than the actual pain itself. While trait-like measures of FOP have emerged as predictors for the inception and development of chronic pain, its neural underpinnings are not well understood. To investigate the relationship between gray matter volumes (GMV) and trait-like individual differences in FOP, we analyzed structural magnetic resonance imaging data in a sample of healthy young adults. Regression analysis results showed that individuals with higher FOP scores displayed higher GMV in brain regions important for the regulation of pain and fear. These brain areas include the pregenual anterior cingulate cortex (ACC), the anterior part of the dorsal ACC, the dorsomedial prefrontal cortex, and the adjacent pre-supplementary motor area. Furthermore, cross-validation analysis confirmed that the identified regional GMV offered a reliable neural signature of trait-like FOP. Our findings shed more light on the neuroanatomical architecture of FOP in currently pain-free people, which may be helpful to guide early interventions to prevent FOP from becoming chronic. [ABSTRACT FROM AUTHOR]

Piriformis syndrome is a form of sciatica caused by compression of the sciatic nerve by the piriformis muscle. It is a relatively uncommon, but not insignificant, cause of sciatica. The diagnosis of piriformis syndrome is complicated by the large differential diagnosis of low back and buttock pain with many diagnoses having overlapping symptoms. This narrative review highlights the relevant anatomy, history, physical exam maneuvers, electrodiagnostic findings, and imaging findings that are used to diagnose piriformis syndrome. Also discussed are posterior gluteal myofascial pain syndromes that mimic piriformis syndrome. The review then outlines the different treatment options for piriformis syndrome including conservative treatment, injections, and surgical treatment. In addition, it provides the reader with a clinical framework to better understand and treat the complex, and often misunderstood, diagnosis of piriformis syndrome. [ABSTRACT FROM AUTHOR]

Purpose: To present and quantify the effectiveness of a method for the efficient production of 169Yb high‐dose‐rate brachytherapy sources with 27 Ci activity upon clinical delivery, which have about the same dose rate in water at 1 cm from the source center as 10 Ci 192Ir sources. Materials: A theoretical framework for 169Yb source activation and reactivation using thermal neutrons in a research reactor and 168Yb‐Yb2O3 precursor is derived and benchmarked against published data. The model is dependent primarily on precursor 168Yb enrichment percentage, active source volume of the active element, and average thermal neutron flux within the active source. Results: Efficiency gains in 169Yb source production are achievable through reactivation, and the gains increase with active source volume. For an average thermal neutron flux within the active source of 1 × 1014 n cm−2 s−1, increasing the active source volume from 1 to 3 mm3 decreased reactor‐days needed to generate one clinic‐year of 169Yb from 256 days yr−1 to 59 days yr−1, and 82%‐enriched precursor dropped from 80 mg yr−1 to 21 mg yr−1. A resource reduction of 74%–77% is predicted for an active source volume increase from 1 to 3 mm3. Conclusions: Dramatic cost savings are achievable in 169Yb source production costs through reactivation if active sources larger than 1 mm3 are used. [ABSTRACT FROM AUTHOR]