Ineffective Common Shoulder Treatments Identified

A new study concludes that a combination of saline injection and ultrasound-guided irrigation in the treatment of shoulder calcific tendinopathy is no more effective than a placebo treatment, calling into question current treatments and calling for further treatment. The need for research and alternative approaches is emphasized.

Results from recent trials suggest that the use of this therapy should be reevaluated.

Recently published clinical trials BMJ A saline injection treatment commonly employed to treat calcific tendinopathy, a painful condition caused by calcium buildup in the rotator cuff tendons of the shoulder, has a significant It turns out that there is no advantage.

The study found that the perceived benefits of ultrasound-guided irrigation (a procedure in which calcium deposits are injected with saline to dissolve them), even when combined with steroid injections, are no greater than those gained from sham (placebo) treatment. It has been demonstrated that it is equivalent to

Researchers say the findings call into question the use of ultrasound-guided irrigation for this condition and should lead to a “significant reconsideration” of existing treatment guidelines.

Research background and methodology

Despite its widespread use, ultrasound-guided irrigation has never been compared to sham treatment, and it remains unclear whether the reported improvements are due to the treatment itself, natural recovery over time, or It is unclear whether this is due to a placebo effect.

To fill this important evidence gap, researchers from Norway and Sweden are the first to test the true effectiveness of ultrasound-guided irrigation with steroid injections in patients with shoulder calcific tendinopathy. A sham control study was conducted.

Their findings show that between April 2015 and March 2020, 218 adults (average age 50 years old, approximately 65% ​​female).

At the beginning of the trial, patients provided information about various health and lifestyle factors, and X-rays were taken to assess the size of their calcium deposits.

Patients were then randomly divided into three treatment groups. Washing and steroid injection (73 participants), sham washing and steroid injection (74 participants), and sham only (71 participants). After treatment, all patients were asked to complete a home exercise program.

Evaluation and results

The primary measures of interest were pain intensity and functional disability on the Oxford Shoulder Score (0-48 point scale) reported by the patient at 2 weeks, 6 weeks, and 4, 8, 12, and 24 months. was.

At 4 months, there were no significant differences in pain and functional limitations between the three groups. At subsequent evaluations, scores remained similar even in patients whose calcium deposits had disappeared, which the researchers say casts doubt on the notion that lysis of periarticular calcium resolves symptoms. Says.

The steroid injection group reported better pain relief than the sham group at 2 and 6 weeks post-treatment, but of note, after 4 months the improvement was no different than the sham group. did not.

Findings and recommendations

Although the researchers acknowledge some limitations, including the lack of an untreated group to assess the natural course of symptoms, the double-blind, three-group design, including a sham group, They stated that they were able to evaluate the true clinical efficacy. Active treatment.

Therefore, they wrote, “Our results question existing recommendations for the treatment of calcific tendinopathy and may require a critical reexamination of established treatment concepts for these patients.” ” concludes.

Future studies should investigate alternative treatments, such as defined physical therapy programs, and should also include no treatment groups to assess the impact of the natural history of calcific tendinopathy on outcomes. the researchers added.

In a linked editorial, US researchers say that cleaning appears to be overused and may not be as effective as we think. However, it would be premature to conclude that ultrasound-guided irrigation or subacromial corticosteroid injections no longer have a role in the treatment of shoulder calcific tendinopathy.

These new findings should inform discussions with patients suffering from similar long-term symptom courses in which time resolves and corticosteroids may promote short-term pain relief. may provide some reassurance to the population,” the researchers added.

And they say future studies should include sham control groups, assess treatment response earlier in the course of symptoms, and investigate whether ultrasound classification systems can better predict treatment response. suggests.

Reference: “Ultrasound-guided lavage with corticosteroid injection versus sham lavage with corticosteroid injection for calcific tendinopathy of the shoulder: a randomized double-blind multi-arm study” Stefan Moosmayer, Ole Marius Ekeberg, Hanna Björnsson Hallgren, Ingar Heier, Synnove Kvalheim, Niels Gunnar Jewell, Jesper Blomquist, Hugo Ripp, Jens Ivor Brox, October 11, 2023, BMJ.
DOI: 10.1136/bmj-2023-076447

This study was funded by the Bergersen Foundation, the Aase Bye and Trygve J.B. Hoffs Foundation, Smith and Nephew, and the Medical Research Council of South East Sweden.

Source: scitechdaily.com

Experts Uncover the Key to Student Success in Education

Research by the University of South Australia and its partners shows that increasing student engagement with complex learning tasks significantly improves critical thinking and problem-solving skills. This study suggests that teachers should focus on deep learning techniques to improve student outcomes.

High engagement, high returns. This is advice from education experts at the University of South Australia for teachers looking to improve student performance.

In a new study conducted in partnership with
flinders university
Researchers from the Melbourne School of Education found that fewer than a third of teachers engage students in complex learning, limiting students’ opportunities to develop critical thinking and solve problems. Did.

Researchers who filmed and assessed classroom content in South Australia and Victoria found that nearly 70% of student assignments consisted of simple questions and answers and notes, rather than activities that engaged students on a deeper level. I found that it is related to superficial learning such as taking things and listening to the teacher.

Emphasis on deep learning

UniSA researcher Dr Helen Stevenson said teachers needed more support to plan interactive and constructive lessons that foster deep learning.

“When it comes to learning, the greater the engagement, the deeper the learning. But too often, students are not very active and do passive work,” says Dr. Stevenson. Masu

“Our research suggests that about 70% of classroom content may be ‘passive’ (students have little observable input), or doing something simple like answering questions on a fact sheet. was considered to be “active”. While there is certainly a place for such tasks in the classroom, student learning is greatly enhanced when students spend more time doing complex activities that promote deep conceptual learning. Deep learning requires organizing knowledge into conceptual structures, which has been shown to improve information retention and improve learning outcomes. Deep learning also supports the knowledge needed for innovation. Making small changes to teachers’ existing lesson plans and instruction can significantly increase student engagement, which in turn improves overall outcomes. ”

She continues: “At a basic level, teachers need to consider how they can adjust existing classroom activities to place more tasks deeper into the learning scale. For example, suppose you watch a video. . Students can watch the video silently (this is “passive”). Watch the video and take notes using the presenter’s words (this is considered “active”). Write any questions that arise while watching the video (this is “constructive”). Or watch the video and discuss it with other students to generate different ideas (this is ‘interactive’). Interactive classroom engagement involves students participating in activities with other students and receiving stimulation that fosters deeper understanding. They make judgments, propose and criticize arguments and opinions, and come up with solutions to problems. These activities also help develop critical thinking and reasoning skills. All of these are predictive of learning gains. ”

Survey results regarding teacher awareness

Interestingly, one of the study’s key findings is that many teachers do not recognize or fully appreciate the importance of how classroom assignments can stimulate different modes of student participation. It seems like it hasn’t.

“Simply changing class activities from ‘active’ to ‘constructive’ can go a long way in improving student learning,” says Dr. Stevenson.

“Teachers should be supported to engage in professional development to shift their thinking to practices that support deeper learning and better outcomes for students.”

References: “Using the Extended ICAP-Based Coding Guide as a Framework for Analyzing Classroom Observations,” by Stella Vosniadou, Michael J. Lawson, Erin Bodner, Helen Stephenson, David Jeffries, and I Gusti Ngurah Darmawan; April 13, 2023 Education and teacher education.
DOI: 10.1016/j.tate.2023.104133

This research was funded by the Australian Research Council.

Source: scitechdaily.com

Discovery of a ‘Quantum Switch’ Controlling Photosynthesis by Scientists

A new study reveals the quantum switching mechanism of light-harvesting complex II (LHCII), which is critical for efficient photosynthesis. This discovery, achieved through advanced cryo-EM and theoretical calculations, supports a dynamic role for LHCII in regulating energy transfer in plants. Credit: SciTechDaily.com

Photosynthesis is an important process that allows plants to use sunlight to convert carbon dioxide into organic compounds. Light-harvesting complex II (LHCII) consists of dye molecules bound to proteins. It alternates between two main roles. Under strong light, excess energy is dissipated as heat through non-photochemical quenching, and under weak light, light is efficiently transferred to the reaction center.

Recent bioengineering research has revealed that faster switching between these functions can improve photosynthetic efficiency. For example, soybean crops showed yield increases of up to 33%. However, the precise atomic-level structural changes in LHCII that cause this control have not been known until now.

The molecular mechanism of NPQ and acidity-induced changes in several key structural factors cause the LHCII trimer to switch between light-harvesting and energy-quenching states.Credit: Institute of Physics

innovative research approach

In the new study, researchers led by Professor Weng Yuxiang from the Institute of Physics, Chinese Academy of Sciences, in collaboration with Professor Gao Jiali’s group from the Shenzhen Bay Institute, combined single-particle cryo-electron microscopy (cryo-EM) research. Using multistate density functional theory (MSDFT) calculations of energy transfer between photosynthetic pigment molecules, we analyzed the dynamic structure of his LHCII at atomic resolution and identified photosynthetic pigment quantum switches for intermolecular energy transfer. Masu.

As part of the study, they developed a series of six cryogenic states, including energy transfer states with LHCII in solution and energy quenching states with laterally confined LHCII in membrane nanodisks under neutral and acidic conditions. reported the EM structure.

Comparing these different structures shows that LHCII undergoes a structural change upon acidification. This change allosterically changes the interpigment distance of the fluorescence quenching locus lutein 1 (Lut1)-chlorophyll 612 (Chl612) only when LHCII is confined to membrane nanodiscs, leading to the quenching of excited Chl612 by Lut1. cause. Therefore, lateral pressure-confined LHCII (e.g., aggregated LHCII) is a prerequisite for non-photochemical quenching (NPQ), whereas acidThe induced conformational change enhances fluorescence quenching.

Cryo-EM structures of LHCII in nanodiscs and surfactant solutions at pH 7.8 and 5.4. Credit: Institute of Physics

Quantum switching mechanism in photosynthesis

Through cryo-EM structures and MSDFT calculations of known crystal structures in the extinction state and transient fluorescence experiments, an important quantum switching mechanism of LHCII with the Lut1-Chl612 distance as a key factor was revealed.

This distance controls the energy transfer quantum channels in response to lateral pressure and conformational changes to LHCII. That is, a small change in the critical distance of 5.6 Å allows a reversible switch between light collection and excess energy dissipation. This mechanism allows for rapid response to changes in light intensity, achieving both high efficiency and efficiency. photosynthesis Balanced photoprotection using LHCII as a quantum switch.

Fluorescence decay rate, relationship of Lut1–Chl612 electronic bond strength to Lut1–Chl612 separation distance, and plot of Lut1–Chl612 distance versus crossing angle of TM helices A and B in different LHCII structures. Credit: Institute of Physics

Previously, these two research groups collaborated on molecular dynamics simulations and ultrafast infrared spectroscopy experiments to propose that LHCII is an allosterically controlled molecular machine. Their current experimental cryo-EM structure confirms previously theoretically predicted structural changes in his LHCII.

Reference: “Cryo-EM structure of LHCII in photoactive and photoprotected states reveals allosteric control of light harvesting and excess energy dissipation” Meixia Ruan, Hao Li, Ying Zhang, Ruoqi Zhao, Jun Zhang, Yingjie Wang , Jiali Gao, Zhuan Wang, Yumei Wang, Dapeng Sun, Wei Ding, Yuxiang Weng, August 31, 2023, natural plants.
DOI: 10.1038/s41477-023-01500-2

This research was supported by a project of the Chinese Academy of Sciences, the National Natural Science Foundation of China, and the Shenzhen Science and Technology Innovation Committee.

Source: scitechdaily.com