Iindidi ezininzi zeentloko zinokuchaphazela umntu oqhelekileyo kwaye nganye inokubangela ngenxa yokulimala kunye / okanye iimeko, nangona kunjalo, iintloko zentloko ezihlala zikhona zihlala zinesizathu esimbaxa emva kwazo. Uninzi lweengcali zononophelo lwempilo kunye nophando oluninzi olusekwe kubungqina obugqityiweyo bagqibe kwelokuba ukuthotywa entanyeni, okanye ukungalungelelaniswa kakuhle kwamathambo omqolo womlomo wesibeleko, sesona sizathu siqhelekileyo sokuqaqanjelwa yintloko. I-Migraine ibonakaliswa yintlungu ebuhlungu yentloko uqobo echaphazela icala elinye lentloko, ihamba nesicaphucaphu kunye nombono ophazamisayo. Intloko ye-Migraine inokunciphisa. Olu lwazi lungezantsi luchaza imeko yesifundo malunga nefuthe lokuhlengahlengiswa kwe-atlas vertebrae kwizigulana ezine-migraine.

 

Impembelelo ye-Atlas Vertebrae Ukunyaniseka kwiZifundo zeMigraine: IsiFundo seSigqeba soPhando

 

Abstract

 

Intshayelelo. Kwimeko yesifundo se-migraine, iimpawu zentloko ziyancipha kakhulu ngokunyuka kwenkcazo yokuthobela ukulandelwa kwemigaqo elandela ukulungiswa kwe-atlas vertebrae. Olu pho nonongo lwe-neurologist efunyenwe ngeziphumo ze-migraine ukufumana ukuba iziganeko ezifunyenweyo ziphindaphindiwe kwisiseko, iveki ezine kunye neveki yesibhozo, emva kokungenelela koMbutho weSizwe ophezulu weCervical Chiropractic. Iziphumo ezisesekondari zibandakanya imilinganiselo ethile yemigangatho yempilo. Iindlela. Emva kokuvavanywa yi-neurologist, amavolontiya atyikitye iifom zokuvuma kwaye zizaliswe iziphumo ezithile ze-migraine. Ubuninzi bee-atlas ukungalungiswanga kwavumela ukufakwa kokufunda, ukuvumela ukuqokelela idatha ye-MRI. Ulondolozo lweChiropractic lwaqhubeka kwiiveki ezisibhozo. I-postintervention reimaging yenzeke ngeveki ezine kunye neveki ezisibhozo ezihamba kunye neziphumo ezithile ze-migraine. Iziphumo. Izifundo ezintlanu kwezilishumi elinanye zibonise ukwanda kwiphumo eliphambili, ukuthotyelwa komsebenzi; nangona kunjalo, ithetha ukuba utshintsho olubanzi alubonisi ukubaluleka kobalo. Ukuphela kokufundwa kuthetha ukutshintshwa kweziphumo zokuhlolwa kweempembelelo ezithile, isiphumo sesibini, kubonakaliswe ukuphuculwa koluphawu olusisiseko kwiimpawu zokunciphisa iintsuku zentloko. Ingxoxo. Ukungabikho kokunyuka okunamandla kokuthotyelwa kunokuqondwa yi-logarithmic kunye ne-dynamic nature ye-intracranial hemodynamic kunye ne-hydrodynamic flow, okuvumela ukuba ngamnye umntu achaze ukuthotyelwa kokutshintsha xa kungenjalo. Iziphumo zophando zibonisa ukuba ukungenelela kwe-atlas ukungenelela kungabandakanywa nokunciphisa imvama ye-migraine kunye nokuphuculwa kwempembelelo ebomini obanikezela ukunciphisa okunzulu ukukhubazeka okuchaphazelekayo kwentloko njengoko kuboniswe kulolu qela. Ukufunda ngokuzayo kunye nokulawula kuyimfuneko, nangona kunjalo, ukuqinisekisa ezi ziphumo. Inombolo yokubhalisa yeCliniki ye-ClinicalTrials yi-NCT01980927.

 

intshayelelo

 

Kuphakanyisiwe ukuba i-atlas vertebra engachanekanga idala ukuphazamiseka kwentambo yomgogodla ukuphazamisa ukugcwala kwe-neural ye-brain stem nuclei kwi-medulla oblongata ehlanganisa i-physiology eqhelekileyo [1 4].

 

Injongo yoMbutho weSizwe oPhezulu weSibeleko seChiropractic (NUCCA) iphuhlise inkqubo yokulungiswa kweatlasi kukubuyiselwa kwezakhiwo zomqolo ezingalunganga kumgca othe nkqo okanye kumxhuzulane. Ichazwe njengomgaqo wokubuyiselwa, ulungelelwaniso kwakhona lujolise ekumiseni kwakhona ubudlelwane obuqhelekileyo besigulana se-biomechanical yomqolo womlomo wesibeleko kwi-axis ethe nkqo (umgca womxhuzulane). Ukubuyiselwa kuphawulwa njengolungelelwaniso loyilo, ukubanakho koluhlu olungashukumiyo lokuhamba, kunye nokuvumela ukwehla okubonakalayo kuxinzelelo lwamandla omxhuzulane [3]. Ukulungiswa kwethiyori kususa ukuphambuka kwentambo, okwenziwe kukungalungelelaniswa kwee-atlasi okanye i-atlas subluxation complex (ASC), njengoko ichaziwe ngokukodwa yi-NUCCA. Umsebenzi we-Neurologic ubuyisiwe, kucingelwa ukuba ukwingqondo ye-autonomic nuclei yengqondo, echaphazela inkqubo ye-cranial vascular system equka iCerebrospinal Fluid (CSF) [3, 4].

 

Inkcazo yokuthobela i-intracranial (ICCI) ibonakala iyona vavanyo olubucayi ngakumbi lweenguqu ezenziwe kwiimpawu ze-craneospinal biomechanical kwizigulane ezibonakalisa ukwedlula i-parameters of hydrodynamic parameters ye-CSF flow flow and measurement displacement measurements [5]. Ngokusekelwe kulolu lwazi, ulwalamano lwangaphambili olwalubonakalayo lwentsebenzo yokunyanzelisa ukunyanzeliswa kweempawu ze-migraine emva kokuhlaziywa kwee-atlas zanikezela inxaxheba ekusebenziseni ii-ICCI njengenjongo yesifundo esiyintloko.

 

I-ICCI ichaphazela ubuchule beNkqubo yeNervous Nervous (CNS) ukulungiselela ukuguquguquka kwevolumu ye-physologic eyenzekayo, ngaloo ndlela igweme ischemia yezakhiwo ze-neurologic [5, 6]. Iimeko zokuthobela ukuphakama okuphezulu kwenza ukuba naluphi na ukwanda kwenani lenzeke kwi-CNS ye-intrathecal ngaphandle kokubangela ukunyuswa kwengcinezelo eyenzekayo ngokukodwa ngokubakho kokungena kwexesha ngexesha le-syole [5, 6]. Ukuphuma kuvela kwindawo ye-supine nge-veins jugular yangaphakathi okanye xa uthe tye, nge-paraspinal okanye kwi-sec Le plexus enobukhulu bendiza i-valleys and anastomotic, ivumela igazi ukuba liqhume kwi-direction retrograde, ukuya kwi-CNS ngokusebenzisa utshintsho lwangemva kwesikhashana [7, 8]. Umsele wamanzi udlala indima ebalulekileyo ekulawuleni inkqubo ye-flux ye-intracranial fluid [9]. Ukuthotyelwa kubonakala kusebenza kwaye kuxhomekeka kwi-free egress yegazi ngokusebenzisa le ndlela yokuhambisa amanzi emininzi ye-extracranial [10].

 

Ukulimala kwentloko nentamo kungenza umsebenzi ongaqhelekanga we-plexus ye-spinal venous that can affect the spinal venous drainage, mhlawumbi ngenxa yokungasebenzi ngokuzimela kwintambo yomgudu we-spinal cord ischemia [11]. Oku kunciphisa indawo yokuhlala yokuguquka kwenani ngaphakathi kwekrebhu ekwakheni ukuthotyelwa kokuthotyelwa komthetho.

 

I-Damadiya ne-Chu ichaza ukubuyela kwe-CSF evaliweyo yokuphuma ephakathi kwe-C-2, ebonisa ukunciphisa i-28.6% ye-CSF ye-gradient ye-pressure gradient kwisigulane apho i-atlas iye yaxhaswa ngokufanelekileyo [12]. Isigulana sichaza inkululeko kwiimpawu (vertigo kunye nokuhlanza xa i-recumbent) ihambelana nama-atlas asele ngokulungelelaniswa.

 

Uphononongo loxinzelelo lwegazi usebenzisa ungenelelo lwe-NUCCA lubonisa indlela enokwenzeka yokuncipha koxinzelelo lwegazi kunokubangelwa lutshintsho ekujikelezeni kobuchopho ngokunxulumene neatlas vertebrae position [13]. Kumada okqhubekayo. Uphando lwe-trigeminal-vascular mechanism kwingqondo yokulawula uxinzelelo lwegazi [14, 15]. Goadsby okqhubekayo. banikeze ubungqina obunyanzelisayo bokuthi i-migraine ivela kwinkqubo ye-trigeminal-vascular system edibeneyo ngengqondo yengqondo kunye nomqolo ophezulu wesibeleko [16-19]. Ukuqwalaselwa komkhosi kubonisa ukwehla okubonakalayo kokukhubazeka kwentloko yezigulana zentloko emva kokulungiswa kwe-atlas. Sebenzisa izifundo ezichongiweyo ze-migraine kubonakale kufanelekile ekuphandeni utshintsho olucetywayo lokujikeleza kobuchopho kulandela ukuhlengahlengiswa kwee-atlas njengoko bekufundisiwe kwasekuqaleni kwizigqibo zesifundo soxinzelelo lwegazi kwaye kubonakala ngathi kuxhaswe yingqondo enokubakho yoqhagamshelo lwe-trigeminal-vascular connection. Oku kuya kuqhubela phambili ukukhula kwe-pathophysiologic hypothesis ye-atlas misalignment.

 

Iziphumo ezivela kwinqanaba lokuqala lenkqubo libonisa ukunyuka okukhulu kwi-ICCI ngokuncipha kwiimpawu zentloko ze-migraine emva kwe-NUCCA yokulungiswa kwe-atlas. Umntu oneminyaka eyi-62 oneminyaka engama-neurologist ofumana i-migraine engapheliyo ngokuzithandela ngokufunda kwangaphambili emva kwenyanga. Ukusebenzisa i-Phase Contrast-MRI (i-PC-MRI), utshintsho kwiimpawu ze-cerebral hemodynamic kunye ne-hydrodynamic flow parameters zalinganiselwa kwixesha elisezantsi, iiyure ze-72, kwaye emva kweeveki ezine emva kokungenelela kwe-atlas. Inqubo efanayo yokulungiswa kwe-atlas esetyenziselwa isifundo somfutho wexilongo yalandelwa [13]. Iiyure ze-72 emva kokufundwa zibonise utshintsho oluphawulekayo kwi-index ye-compliance (ICCI), ukusuka kwi-9.4 ukuya kwi-11.5, kwi-17.5 ngeveki enye, emva kokungenelela. Ukuqwalaselwa kwenguqu ekuphumeni kwamanzi kunye nesondlo esisekondari esiphezulu kwisikhundla se-supine sifanele ukuba uphando olongezelelweyo lukhuthaze ngakumbi uphando lwezifundo ze-migraine kulolu hlobo luchungechunge.

 

Imiphumo engabonakaliyo ye-atlas ukungalingani okanye i-ASC kwimigodi ye-venous ayiyazi. Ukuhlola ngokucophelela ukuthotyelwa kokungahambisani nxamnye nemiphumo ye-atlas ukungalungiswanga ukungenelela kunokunika ingqiqo indlela ukulungiswa ngayo kunokuchaphazela intloko ye-migraine.

 

Ukusebenzisa i-PC-MRI, le njongo iphambili ephambili, kunye nomphumo oyintloko, ukulinganisa i-ICCI ishintshe ukusuka kwisiseko ukuya kwiiiveki ezisibhozo ezisibhozo emva kokungenelela kwe-NUCCA kwinqanaba le-neurologist ekhethiweyo. Njengoko kuthethwa kwimeko yokufunda, i-hypothesis ibonisa ukuba i-ICCI yesifundo iya kwanda emva kokungenelela kwe-NUCCA ngokunciphisa ngokufanayo kwimpawu zemigraine. Ukuba kukho, nayiphi na iinguqu ezibonakalayo kwiindawo ezixhamlayo kunye nomzila wamanzi kwakufuneka zibhalwe ukuba zifaniswe ngokuthelekiswa. Ukuqwalasela iimpendulo zeempawu zentsholongwane, iziphumo zesibini ziquka izigulane ezichazwe zizigulane ukulinganisa nayiphi na utshintsho oluthile kwi-Health Quality Quality of Life (HRQoL), esetyenziswa ngokufanayo kwi-migraine yophando. Kulo lonke uhlolisiso, izifundo zigcinwe zi-diaries ezibhalwe ngentloko zibhalisa ukunciphisa (okanye ukwandisa) kwinani leentsuku zentloko, ubunzulu kunye namayeza asetyenziswayo.

 

Ukuqhuba le nkcazo yecala lokuqwalasela, isifundo somqhubi, avunyelwe uphando olongezelelweyo kwimiphumo ye-physiologic ekhankanyiweyo ngasentla ekuphuhliseni phambili kweengcamango zokusebenza kwi-pathophysiology ye-atlas misalignment. Iinkcukacha ezifunekayo ekuqikelelweni kwezibalo zesisampuli ezibalulekileyo kunye nokuxazulula imingeni yeenkqubo ziza kunika ulwazi olufunekayo ekuphuhliseni umgaqo-nkqubo ococekileyo wokuqhuba isilingo esilumkileyo, esinokulawulwa kwe-migraine esilumkileyo, esisebenzisa i-NUCCA yokulungiswa kwamanyathelo.

 

tindlela

 

Olu phando lugcine ukuthotyelwa kweSibhengezo saseHelsinki sophando kwizifundo zabantu. IYunivesithi yaseCalgary kunye neAlberta Health Services Conjoint Board Ethics Board ivumile umthetho olandelwayo kunye nefom yemvume yolwazi, i-ID ye-Ethics: E-24116. IClinicalTrials.gov yabela inombolo ye-NCT01980927 emva kokubhaliswa kolu phando (clinicaltrials.gov/ct2/show/NCT01980927).

 

Ukuqashwa kwabafundi kunye nokuhlolwa kwenzeke kwiCalgary yokuHlola kwentloko yeNtloko kunye noLawulo lweNkqubo (CHAMP), ikliniki yokuhanjiswa kweengcali ezisekelwe kwi-neurology (jonga umfanekiso 1, iThebhile 1). I-CHAMP ihlola izigulane ezinganyangekiyo kwi-pharmacotherapy eqhelekileyo kunye unyango lwe-migraine ekhanda elingakhange lunikeze impawu zokunceda imithi ye-migraine. Oogqirha bentsapho kunye nonyango oluphambili babhekisela kwizifundo zokufunda ezinokubakho kwi-CHAMP ekwenzeni iintengiso ezingenasidingo.

 

 

 

Ukufakwa kufundo kufuna amavolontiya, aphakathi kweminyaka ye-21 kunye ne-65 iminyaka, eyanelisa imigaqo ethile yokuqonda isifo se-migraine. I-neurologist eneeminyaka emininzi yamava e-migraine ahlolwe abafakizicelo abasebenzisa i-International Classification of Headache Disorders (ICHD-2) yokufunda ukubandakanywa [20]. Izifundo ezinokubakho, i-na ve kukhathalelo oluphezulu lwe-chiropractic yomlomo wesibeleko, kufuneka ibonakalise ngokwenza ingxelo phakathi kweentsuku ezilishumi kunye namashumi amabini anesithandathu entloko ngenyanga kwiinyanga ezine ezidlulileyo. Ubuncinane iintsuku ezisibhozo zentloko ngenyanga kwakufuneka zifikelele kubuncinane ubuncinane kwi-zero ukuya kwi-24 ye-VAS intlungu yesikali, ngaphandle kokuba uphathwe ngempumelelo ngonyango oluthile lwe-migraine. Ubuncinci ezine iziqendu zentloko ezahlukileyo ngenyanga ezahlulwe ubuncinci iyure ye-XNUMX yexesha elingenazintlungu.

 

Intloko ebalulekileyo okanye intlungu yokunyamezela intliziyo eyenzeka ngonyaka ongaphambi kokufundwa kokungena ngaphandle kwabaviwa. Iimpawu zokungabikho ezingakumbi zibandakanya amayeza amaninzi, imbali ye-claustrophobia, isifo senhliziyo okanye isifo se-cerebrovascular, okanye nayiphi na ingxaki ye-CNS ngaphandle kwe-migraine. Itheyibhile 1 ichaza iinkqubo ezipheleleyo ezibandakanyiweyo kunye nokukhutshwa ngaphandle. Ukusebenzisa i-board yezemfundo ye-neurologist eqinisekisiweyo yokufunda iikhompyutheni ezinokuthi zihambelane ne-ICHD-2 kwaye zikhokelwa yinkqubo yokungeniswa / yokukhutshwa ngaphandle, ukukhutshwa kwezifundo kunye nemithombo yeentloko ezifana nokuxhatshazwa kwe-muscular kunye neyeza elongezelelekileyo kwintloko yesicatshulwa kunokunyusa amathuba okuphumelela ukuqashwa kwamabanga.

 

Abo badibanisa imigaqo-nkqubo yokuqala basayine imvume enolwazi kwaye bagqiba isiseko seMigraine Disability Assessment Scale (MIDAS). I-MIDAS idinga iiveki ezilishumi elinambini ukubonisa utshintsho olusisigxina kwikliniki [21]. Oku kwavumela ixesha elaneleyo lokupasa ukuqonda nayiphi na inguqu enokwenzeka. Ngethuba leentsuku ezilandelayo ze-28, abaviwa barekhoda idayari yekhanda lokunika i-headline yedatha enikezela idatha yesiseko xa beqinisekisa inani leentsuku zentloko kunye nobukhulu obufunekayo ukuze kufakwe. Emva kweeveki ezine, idayari ihlolisise ukuxilongwa kwemvume yokulawulwa kwemilinganiselo eseleyo ye-HRQLL eseleyo:

 

1. Imilinganiselo eyi-Migraine-Quality Specification of Life Measure (MSQL) [22],
2. I-Headache Impact Test-6 (HIT-6) [23],
3. Uvavanyo olukhoyo jikelele lweentlungu zentlungu (VAS).

 

Ukuthunyelwa kwingcali ye-NUCCA, ukumisela ubukho be-atlas ukungalungelelaniswa, ukuqinisekiswa kwesidingo songenelelo ukugqibezela ukubandakanywa kwesifundo? Ukungabikho kwezalathi zokungalungelelaniswa kakuhle kweeatlasi ngaphandle kwabagqatswa. Emva kokucwangcisa ukuqeshwa kongenelelo lwe-NUCCA kunye nokhathalelo, izifundo ezifanelekileyo zifumene amanyathelo okusisiseko e-PC-MRI. Umzobo 1 ushwankathela imeko yesifundo kulo lonke uphononongo.

 

Ungenelelo lokuqala lwe-NUCCA ludinga ukutyelelwa kathathu ngokulandelelana: (1) Usuku lokuQala, uvavanyo lokungalungelelaniswa kakuhle kwee-atlas, ngaphambi kokulungiswa kwe-radiographs; (2) Usuku lwesibini, ukulungiswa kwe-NUCCA kunye novavanyo lwasemva kokulungiswa kunye ne-radiographs; kunye (3) nosuku lwesithathu, emva kokulungiswa kwakhona kokulungiswa. Unonophelo olulandelayo lwenzeka veki nganye iiveki ezine, emva koko kwiiveki ezimbini eziseleyo kwixesha lokufunda. Kutyelelo ngalunye lwe-NUCCA, izifundo zigqityiwe kuvavanyo lwangoku lwentloko ebuhlungu (nceda ulinganise iintlungu zentloko yakho ngokomndilili kwiveki ephelileyo) usebenzisa umda ochanekileyo kunye nepensile ekuphawuleni umgca we-100? Mm (VAS). Kwiveki enye emva kongenelelo lokuqala, izifundo zigqibile iphepha lemibuzo elinokuthi "Ukuphendula okunokwenzeka kwiKhathalelo". Olu vavanyo sele lusetyenziselwe ukubeka esweni ngempumelelo imicimbi emibi enxulumene neenkqubo ezahlukeneyo zokulungiswa komlomo wesibeleko [24].

 

Ngeveki ezine, iinkcukacha ze-PC-MRI zifunyenwe kwaye izifundo zigqitywe nge-MSQL kunye ne-HIT-6. Ukuphela kwedatha ye-PC-MRI yaqokelelwa kwiveki yesibhozo elandelwa yintetho ye-neurologist exit interview. Apha, izifundo ezigqityiweyo zokugqibela ze-MSQOL, i-HIT-6, i-MIDAS, neziphumo ze-VAS kunye neodayari diary ziqokelelwa.

 

Ngeveki-8 i-neurologist ukutyelela, izifundo ezimbini ezizinikeleyo zinikezelwa ithuba elide lokulandela ixesha elide lokufunda kwiiveki ze-24. Oku kubandakanya ukuhlaziywa kwakhona kwe-NUCCA rhoqo ngenyanga ngeeveki ze-16 emva kokugqitywa kwesifundo se-8-veki yokuqala. Injongo yalo mlandeleko kukukunceda ukuba ingqalelo ukuba ukuphuculwa kwentloko kwaqhubeka nokuqhubeka nokugcinwa kokulungelelaniswa kwee-atlas ngeli gama ukujonga nayiphi na igalelo lexesha elide leNUCCA ngononophelo kwi-ICCI. Izifundo ezinqwenela ukuthatha inxaxheba zisayine imvume yesibini enolwazi lwale nqanaba lokufunda kwaye yaqhubeka yonyango lweNUCCA ngenyanga. Ekupheleni kweeveki ze-24 ezivela kwingenelelo yangaphambili ye-atlas, isifundo sesine se-PC-MRI esifundo senzeke. Kwi-interview ye-neurologist exit interview, i-MSQOL yokugqibela, i-HIT-6, i-MIDAS, kunye ne-VAS neziphumo kunye needayari zentloko zaqokelelwa.

 

Inkqubo efanayo ye-NUCCA njengoko bekuxeliwe ngaphambili yayilandelwa kusetyenziswa umgaqo olandelwayo kunye nemigangatho yokhathalelo ephuhliswe ngesiQinisekiso se-NUCCA sovavanyo kunye nokulungiswa kwe-atlas okanye ukulungiswa kwe-ASC (jonga amanani? Uvavanyo lwe-ASC lubandakanya ukuvavanywa kokungalingani kwemilenze esebenzayo kunye ne-Supine Leg Check (SLC) kunye nokuvavanywa kolingano lwasemva kokusebenzisa iGravity Stress Analyzer (Upper Cervical Store, Inc., 22 5 Avenue, Campbell River, BC, Canada V2W 13L25 Amanani1641 kunye 17 (a) 9 (c)) [4-5]. Ukuba i-SLC kunye nokungalingani kwangemva kokubonakala kufunyenwe, kuvavanyo lwe-radiographic olunemibono emithathu luboniswa ukumisela ulwazelelo olunemilinganiselo emininzi kunye nenqanaba le-craniocervical misalignment [22, 3]. Uhlalutyo oluchanekileyo lwe-radiographic lubonelela ngolwazi ukumisela umxholo othile, isicwangciso esiliqili sokulungiswa kwee-atlas. Ugqirha ubeka amanqaku e-anatomic avela kuthotho lweembono ezintathu, ukulinganisa ii-angles zesakhiwo kunye nokusebenza okuyekile kwimigangatho esekwe ye-orthogonal. Inqanaba lokungalungelelaniswa kakuhle kunye nokuqhelaniswa kwe-atlas emva koko kutyhilwa kumanqanaba amathathu (jonga amanani 3 (a) -26 (c)) [28, 29, 30]. Ukulungelelaniswa kwezixhobo zeRadiographic, ukunciphisa ubungakanani bezibuko zeklolimator, indibaniselwano yescreen esineefilimu, iifilitha ezikhethekileyo, iigridi ezikhethekileyo, kunye nokukhokela ukukhusela ukunciphisa ukubonakaliswa kwemitha yesifundo. Kolu phononongo, umndilili opheleleyo wokulinganiswa kokuBonakaliswa koLusu kwizifundo ezivela kuthotho lwe-radiographic yangaphambi kokulungiswa yayiyi-4 millirads (4 millisieverts).

 

 

 

 

 

Ukungenelela kwe-NUCCA kuqukwa ukulungiswa ngokulandelelwaniswa kwesalathisi sokulinganisa ngokwemvelo kwisakhiwo se-anatomiki phakathi kwekhayi, i-atlas vertebra, kunye nentambo yomlomo wesibeleko. Ukusebenzisa imigaqo-mali ye-biomechanical esekelwe kwinkqubo ye-lever, ugqirha uphuhliso isicwangciso esifanelekileyo

 

1. ukubeka isifundo,
2. ugqirha,
3. nyanzela i-vector ukulungisa i-atlas.

 

Izifundo zifakwe kwitafile yecala-posture kunye nentloko ekhonkxiwe ngokusetyenziswa kwenkqubo yokweseka i-mastoid. Ukusetyenziswa kwevolisi yamandla okulawulwa kwangaphambili ekulungiseni ukulungiswa kuyayifakela ingqayi kwi-atlas nentamo kwi-axis ecacileyo okanye kwisiko sobunzima bomgudu. Le mizi yokulungisa ilawulwa kwinqanaba, isalathiso, i-velocity, kunye ne-amplitude, ukuvelisa ukuchithwa okuchanileyo nokuchanekileyo kwe-ASC.

 

Sebenzisa ithambo le-pisiform yesandla sokunxibelelana, ugqirha we-NUCCA unxibelelana nenkqubo ye-atlas enqamlezileyo. Esinye isandla sijikeleza isiqwenga sesandla sokunxibelelana, ukulawula i-vector ngelixa sigcina ubunzulu bamandla avelisiweyo ekusebenziseni inkqubo ye-rictriceps pull (jonga umfanekiso 5) [3]. Ngokuqonda i-spinal biomechanics, umzimba weengcali kunye nezandla zihambelana ukuvelisa ukulungiswa kwee-atlas kunye ne-vector force. Amandla alawulwayo, anganyusiyo asetyenziswa ecaleni kwendlela emiselwe kwangaphambili yokunciphisa. Icacile kwicala layo kunye nobunzulu bayo ukulungiselela ukunciphisa ukunciphisa kwe-ASC kungabikho kusebenze kwimikhosi esebenzayo yemisipha yentamo ekuphenduleni kutshintsho lwe-biomechanical. Kuyaqondakala ukuba ukuncitshiswa ngokupheleleyo kokungalungelelani kukhuthaza ulondolozo lwexesha elide kunye nozinzo lolungelelwaniso lomqolo.

 

Ukulandela ixesha elifutshane lokuphumla, inkqubo yokuvavanya, efana novavanyo lokuqala, lwenziwa. I-postcorrection ye-radiograph examination isebenzisa iimbono ezimbini ukuqinisekisa ukubuyela kwentloko kunye nomlomo wesibeleko ube ngumlinganiselo wokulinganisela. Izifundo zifundiswe ngeendlela zokulondoloza ukulungiswa kwazo, oko kukuthintela ukulungiswa komnye.

 

Ukuhanjelwa kwee-NUCCA ezilandelayo ziquka i-headache diary checks kunye nokuhlolwa kwangoku kwentlungu yesifo (VAS). Ukungalingani kwemilenze kunye nokugqithisa ngokweqile kwesikhombiso esasetyenziselwa ukufumana imfuno yenye ingenelelo ye-atlas. Injongo yokuphucula ngokufanelekileyo kukulungiselela ukulungiswa kwangaphambili, kunokuba kunenani elincinci lokungenelela kwee-atlas.

 

Ngokulandelelana kwe-PC-MRI, amajelo ohlukileyo ayasetyenziswa. Iindlela ze-PC-MRI ziqokelele iiseti ezimbini zedatha ngeemali ezahlukileyo zobutyebi bokuhamba kwemvelo ezifumaneka ngokubambisana ngezibini zentlupheko, elandelelana ngokulandelanayo kunye nokuphindaphinda ngokuphindaphindiweyo ngexesha lokulandelana. Idatha eluhlaza ukusuka kwiiseti ezimbini iyakhutshwa ukubala izinga lokuhamba.

 

Ukutyelelwa kwi-MRI Physicist kwanikezela uqeqesho lwe-MRI Technologist kwaye inkqubo yokudluliswa kwedatha yasungulwa. Ukutshintshwa kweendlela ezininzi kunye nokudluliselwa kwedatha kwenziwa ukuba kuqinisekiswe ukuqokelela idatha ngaphandle kwemingeni. I-1.5-tesla GE 360 I-Optima MR iskrini (iMilwaukee, WI) kwisikhungo sokucinga sokufunda (i-EFW Radiology, iCalgary, i-Alberta, eCanada) isetyenziswe kwimifanekiso kunye nokuqokelela idatha. I-12-element elementary head coil head, i-3D i-magnetization-i-echo graficent echo (i-MP-RAGE) ilandelelwano isetyenziselwa ukulandelwa kwe-anatomy. Idatha evelelekayo ehambayo yafunyanwa ngokusetyenziswa kwendlela efanayo yokufumanisa (iPAT), ukunyuswa kwe-2.

 

Ukulinganisa ukugeleza kwegazi ukuya nokusuka kwisiseko sokhakhayi, ezimbini ezibuyiselwe umva, iscans-encoded cine-phase-phase scans scans zenziwa njengoko kumiselwe yintliziyo nganye, ukuqokelela imifanekiso engamashumi amathathu anesibini kumjikelo wentliziyo. I-encoding ye-high-velocity encoding (70? Cm / s) ye-velocity ephezulu yokuhamba kwegazi ngokuthe ngqo kwiinqanawa kwinqanaba le-C-2 vertebra ibandakanya imithambo yangaphakathi ye-carotid (ICA), imithambo ye-vertebral (VA), kunye nemithambo yangaphakathi yejugular (IJV ). Idatha yokuhamba kwemithambo yesibini yemithambo ye-vertebral veins (VV), imithambo ye-epidural (EV), kunye nemithambo enzulu yomlomo wesibeleko (DCV) yafunyanwa ngobude obufanayo kusetyenziswa i-velocity encoding (7 9? Cm / s) yokulandelelana.

 

Idatha yezifundo zachongwa yi-ID yoFundo lweSihloko kunye nomhla wokufunda. Isifundo se-neuroradiologist sihlalutye ukulandelelana kwe-MR-RAGE ukulawula izimo ze-pathologic exclusionary. Izihlomelo zezifundo zasuswa kwaye zanikwa i-ID ekhowudiweyo evumela ukudluliselwa nge-protocol yomgaqo we-IP ephephile kwi-physicist ukuhlalutya. Ukusebenzisa i-software ye-software ye-volumetric yegazi, i-Cerebrospinal Fluid (CSF) kunye neefometers derived (determined by MRICP version 1.4.35 Noninvasive Diagnostics, Miami, FL).

 

Ukusebenzisa i-lumsity-based segmentation of lumens, ii-flowum volumetric rate rates zibalwe ngokuhlanganisa ukujikeleza kwamanzi ngaphakathi kwimihlaba yezandla zomda ngaphaya kwayo yonke imifanekiso engamashumi amathathu nemibini. Kuthatyathwa intlawulo yokuhamba kwemithambo yentsholongwane yomhlaba, umjelo wamanzi oyimimandla, kunye neendlela eziphambili zokuhambisa amanzi. I-flow total blood cerebral flow washelwa ngokusishwankathela kwezi ntlupheko zentsingiselo.

 

Inkcazo elula yokuthobela ngumyinge wevolumu kunye notshintsho kuxinzelelo. Ukuthotyelwa kwe-intracranial kubalwa ukusuka kumyinge we-maximal (systolic) ye-intracranial volume change (ICVC) kunye nokutshintsha koxinzelelo ngexesha lomjikelo wentliziyo (PTP-PG). Utshintsho kwi-ICVC lufunyenwe kwiyantlukwano yomzuzwana phakathi kwevolumu yegazi kunye ne-CSF yokungena kunye nokuphuma kwekranathi [5, 31]. Utshintsho loxinzelelo ngexesha lomjikelo wentliziyo lithathwa kutshintsho lwe-CSF yoxinzelelo lwegradi, ebalwa ukusuka kwimifanekiso ye-velocity-encoded MR yokuhamba kwe-CSF, kusetyenziswa ubudlelwane beNavier-Stokes phakathi kweziphumo ze velocities kunye noxinzelelo lwegradient [5, 32 ]. Isalathiso sokuthotyelwa kokungahambelani (ICCI) kubalwa ukusuka kumyinge we-ICVC kunye notshintsho kuxinzelelo [5, 31-33].

 

Uhlalutyo lwesatisatisiti luqwalasele izinto ezininzi. Uhlalutyo lweenkcukacha lwe-ICCI lubandakanye uvavanyo oluthile lwe-Kolmogorov-Smirnov olubonisa ukungabikho kokusabalalisa ngokuqhelekileyo kwi-ICCI idatha, leyo leyo ichazwe ngokusetyenziswa kwebala eliphakathi kunye ne-interquartile (IQR). Ukwahlukana phakathi koqhagamshelwano kunye nokulandelelana kwakufuneka kuhlolwe ngokusebenzisa uvavanyo oludibeneyo.

 

Idatha yokuhlola i-NUCCA ichazwe ngokusetyenziswa kwebala, intlupheko kunye ne-interquartile range (IQR). Ukwahlukana phakathi koqhagamshelwano kunye nokulandelelwaniswa kwahlolwa ngokusetyenziswa kovavanyo oludibeneyo.

 

Ngokuxhomekeka kwisilinganiselo sesiphumo, isiseko, isonto elinesine, iveki yesibhozo, kunye neveki elishumi elinesibini (i-MIDAS kuphela) ixabiso lokulandelelana lichazwe kusetyenziswa ukuchasana okuqhelekileyo. Idatha ye-MIDAS eqokelelwe kwi-screening ye-neurologist yokuqala yayinomlinganiselo omnye wokulandelela ekupheleni kweiveki ezilishumi elinesibini.

 

Ukwahlukahlukana ukusuka kwisiseko kusetyenziso olulandelayo luye lwavavanywa usebenzisa uvavanyo oludibeneyo. Oku kubangele ubuninzi bexabiso lep uvela kwiindwendwe ezimbini zokulandelelana kwisiphumo ngasinye ngaphandle kwe-MIDAS. Ekubeni enye injongo yalo mqhubi kukunika uqikelelo lwenkqubela yophando, kubalulekile ukuba uchaze apho kwenzeka ukungaboni ngaso linye, kunokusebenzisa i-ANOVA enye indlela ukuba ifike ngexabiso elilodwa lemilinganiselo nganye. Ukuxhalabisa ngokuthelekiswa okuninzi kukunyuka kwinqanaba leNqanaba Iphutha.

 

Ukuhlalutya idatha ye-VAS, amanqaku ngasinye esikolweni ahlolwe ngabanye kwaye emva komgca wokuguqulwa komgca ohambelana ngokwaneleyo nedatha. Ukusetyenziswa kwemodeli yokunciphisa i-multilevel kunye neentlobo zombini kunye neentlambo ezingaqhelekanga zanikezela umgca wokulungiswa komntu ngamnye olungiselelwe isigulane ngasinye. Oku kuvivinywe ngokubhekiselele kumzekelo ongenawo umqobo, ohambelana nomgca wokuguqulwa komgca kunye nomthamo oqhelekileyo kuzo zonke izifundo, ngelixa ukuchithwa kwemigomo kuvunyelwe ukuhluka. I-model coefficient engacwangciswanga yamkelwa, njengoko kwakungabikho ubungqina bokuba iindawo ezinqabileyo eziphuculweyo ziphucula kakhulu ukulungelelaniswa kwedatha (kusetyenziso lwamanani amaninzi). Ukubonisa ukuhluka kwimiyalelo kodwa kungekhona kwintlambo, imigca yokuguqa yodwa yayigqityiweyo kwisigulane ngasinye kunye nomgca we-regression line.

 

iziphumo

 

Ukusuka kuvavanyo lokuqala lwe-neurologist, amavolontiya alishumi elinesibhozo afanelekile ukubandakanywa. Emva kokugqitywa kweedayari zentloko yesiseko, abaviwa abahlanu abahlangabezananga neekhrayitheriya zokufakwa. Abathathu babeswele iintsuku ezifunekayo zentloko kwiidayari ezisisiseko ukuba zibandakanywe, enye yayineempawu ezingaqhelekanga zemithambo-luvo kunye nokuqaqamba okungahambelaniyo, kwaye enye yayithatha i-calcium channel blocker. Ugqirha we-NUCCA ufumene abagqatswa ababini abangakulungelanga: omnye uswele i-atlas misalignment kwaye owesibini waba nemeko yeWolff-Parkinson-White kunye nokugqwethwa okungathethekiyo kwasemva kwasemva (39 ) ngokubandakanyeka kutshanje kwingozi enkulu yemoto yengozi nge-whiplash (jonga umfanekiso 1) .

 

Izifundo ezilishumi elinanye, abasetyhini ababhinqileyo kunye nabesilisa abathathu, umyinge weminyaka engamashumi amane ananye (uluhlu lwama-21-61 eminyaka), abakulungeleyo ukufakwa. Izifundo ezithandathu zibonise i-migraine engapheliyo, inika ingxelo ngeentsuku ezilishumi elinesihlanu okanye nangaphezulu ngenyanga, inesifundo ngasinye elineshumi elinanye leentsuku ezili-14.5 zentloko ngenyanga. Iimpawu zeMigraine ubude bexesha ukusuka kwiminyaka emibini ukuya kumashumi amathathu anesihlanu (kuthetha iminyaka engamashumi amabini anesithathu). Onke amayeza agcinwa engatshintshanga kwixesha lokufunda ukubandakanya iirejimeni zabo ze-migraine prophylaxis njengoko kumiselweyo.

 

Iintetho zokungabikho, akukho zifundo ezifakiwe zifumene ukuxilongwa kweentloko ezibangelwa ukulimala koluhlungu entloko nasentanyeni, ingxubusho, okanye intloko eqhubekayo ibangelwa yi-whiplash. Izifundo ezi-9 zichazwe kwimbali edluleyo kakhulu, ngaphezu kweminyaka emihlanu okanye ngaphezulu (umyinge weminyaka elithoba) ngaphambi kwesikrini se-neurologist. Oku kwakuquka ukulimala kwentloko enxulumene nemidlalo, ukuxubusha, kunye / okanye i-whiplash. Izifundo ezimbini ziboniswe akukho ntloko ngaphambili okanye inyala yentamo (jonga i-Table 2).

 

 

Ngabanye, izifundo ezihlanu zibonise ukwanda kwe-ICCI, amaxabiso amathathu ezifundo ahlala ngokufanayo, kwaye amathathu abonisa ukwehla ukusuka kwisiseko ukuya esiphelweni semilinganiselo yokufunda. Utshintsho ngokubanzi kuthotyelo lokungasebenzi kakuhle lubonwa kwiTheyibhile 2 kwaye Umzobo 8. Amaxabiso aphakathi (IQR) e-ICCI ayengu-5.6 (4.8, 5.9) kwisiseko, 5.6 (4.9, 8.2) kwiveki yesine, kunye no-5.6 (4.6, 10.0) apha iveki yesibhozo. Umahluko wawungahlukanga ngokwamanani. Umahluko ophakathi kwesiseko kunye neveki yesine yayingu-0.14 (95% CI? 1.56, 1.28), p = 0.834, kwaye phakathi kwesiseko kunye neveki yesibhozo yayingu-0.93 (95% CI? 0.99, 2.84), p = 0.307. Ezi zifundo zimbini zezifundo ze-ICCI zeeveki ezingama-24 zibonwa kwiTheyibhile 6. Isihloko se-01 sibonise imeko eyandayo kwi-ICCI ukusuka kwi-5.02 kwisiseko ukuya kwi-6.69 ngeveki ye-24, ngelixa ngeveki ye-8, iziphumo zazitolikwa njengezingaguqukiyo okanye zihlala zinjalo. Isifundo 02 sibonakalise ukwehla kwe-ICCI ukusuka kwisiseko se-15.17 ukuya kwi-9.47 ngeveki ye-24.

 

 

 

Itheyibhile 3 iingxelo zotshintsho kuvavanyo lwe-NUCCA. Umahluko phakathi kwexesha langaphambi nasemva kongenelelo ungenelelo lulandelayo: (1) SLC: 0.73 intshi, 95% CI (0.61, 0.84) (p <0.001); (2) GSA: amanqaku amanqaku angama-28.36, 95% CI (26.01, 30.72) (p <0.001); (3) Ixesha leAtlas kamva: iidigri ze-2.36, i-95% CI (1.68, 3.05) (p <0.001); kunye (4) Ujikelezo lweAtlas: 2.00 degrees, 95% CI (1.12, 2.88) (p <0.001). Oku kungabonisa ukuba utshintsho olunokwenzeka lwenzekile emva kongenelelo lweatlasi njengoko kusekwe kuvavanyo lwezifundo.

 

 

Iziphumo zedayari zentloko zichazwe kuyo 4 Table kunye noMzobo 6. Kwizifundo ezisisiseko zazine-14.5 (SD = 5.7) iintsuku zentloko ngeentsuku ezingama-28 zenyanga. Ngexesha lenyanga yokuqala elandela ukulungiswa kwe-NUCCA, kuthetha ukuba iintsuku zentloko ngenyanga ziye zehla ngeentsuku ze-3.1 ukusuka kwisiseko, i-95% CI (0.19, 6.0), p = 0.039, ukuya kwi-11.4. Ngexesha lenyanga yesibini iintsuku zentloko yehle ngeentsuku ze-5.7 ukusuka kwisiseko, i-95% CI (2.0, 9.4), p = 0.006, ukuya kwiintsuku eziyi-8.7. Kwiveki yesibhozo, izifundo ezintandathu kwezilishumi elinanye ziye zancitshiswa> iipesenti ezingama-30 kwiintsuku zentloko ngenyanga. Ngaphezulu kweeveki ezingama-24, isifundo se-01 sixele ukuba akukho lutshintsho kwiintsuku zentloko ngelixa isifundo se-02 sinesinciphiso sosuku olunye lwentloko ngenyanga ukusuka kwisiseko sesifundo ezisixhenxe ukuya esiphelweni sengxelo zokufunda zeentsuku ezintandathu.

 

 

Kwinqanaba lokuqala, kuthetha ukuba intloko yamandla entloko ngeentloko, kwinqanaba le-zero ukuya kweshumi, yayingu-2.8 (SD = 0.96). Ubungakanani bentloko obuphezulu obubonisa ukuba akukho tshintsho oluphawulekayo kwiingu-ezine (p = 0.604) kunye neesibhozo (p = 0.158) iiveki. Izifundo ezine (#4, 5, 7, kunye ne-8) zibonise enkulu kunokuba i-20% iyancipha kwi-headache.

 

Umgangatho wobomi kunye nemilinganiselo yokukhubazeka kwentloko ibonakala kwiThebhile 4. Umlinganiselo we-HIT-6 kumgangatho wesiseko ngu-64.2 (SD = 3.8). Ngeveki ezine emva kokulungiswa kwe-NUCCA, ukuthatha ukwehla kwamanani kwaku-8.9, 95% CI (4.7, 13.1), p = 0.001. Iimvavanyo zeveki-ezisibhozo, xa kuthelekiswa nesiseko, kubonakaliswe ukuhla kwe-10.4, 95% CI (6.8, 13.9), p = 0.001. Kwiqela le-24 yeveki, ukuxhomekeka kwe01 kubonisa ukuhla kweengcambu ze-10 ezivela kwi-58 ngeveki 8 ukuya kwi-48 ngeveki 24 ngelixa i-02 i-7 iyancipha amanqaku e-55 kwi-8 ngeveki 48 ukuya kwi-24 ngeveki 9 (jonga umfanekiso XNUMX).

 

 

I-MSQL ithetha ukuba amanqaku asisiseko yayiyi-38.4 (SD = 17.4). Kwiveki yesine emva kokulungiswa, kuthetha ukuba amanqaku kuzo zonke izifundo ezilishumi elinanye anyukile (aphuculwe) nge-30.7, 95% CI (22.1, 39.2), p <0.001. Ngeveki yesibhozo, ukuphela kokufunda, kuthetha ukuba amanqaku e-MSQL anyukile ukusuka kwisiseko nge-35.1, 95% CI (23.1, 50.0), p <0.001, ukuya kuma-73.5. Izifundo ezilandelelweyo ziyaqhubeka nokubonisa ukuphucuka ngamanqaku anyukayo; Nangona kunjalo, amanqaku amaninzi asala ngokufanayo ukusukela kwiveki yesi-8 (jonga amanani 10 (a) -10 (c)).

 

 

Kuthetha ukuba amanqaku e-MIDAS kwisiseko yayingu-46.7 (SD = 27.7). Kwiinyanga ezimbini emva kokulungiswa kwe-NUCCA (iinyanga ezintathu zilandela isiseko), ukwehla kokuthobela amanqaku amanqaku e-MIDAS yayiyi-32.1, 95% CI (13.2, 51.0), p = 0.004. Izifundo ezilandelelanayo ziyaqhubeka nokubonisa ukuphucuka ngamanqaku anciphayo ngoxinzelelo olubonisa ukuphucuka okuncinci (jonga ii-11)

 

 

Ukuvavanywa kwentlungu yangoku yentloko evela kwidatha yesikali se-VAS kubonakala kumzobo 7. Imodeli yokuhlengahlengiswa kwemigca emininzi yabonisa ubungqina besiphumo sokungamkeleki (p <0.001) kodwa hayi kwithambeka (p = 0.916). Ke ngoko, imodeli yokufumana ngokungacwangciswanga eqikelelweyo ithatha indlela eyahlukileyo yesigulana ngasinye kodwa ithambeka eliqhelekileyo. Uqikelelo lwethambeka lalo mgca yayingu-0.044, 95% CI (? 0.055,? 0.0326), p <0.001, ebonisa ukuba kukho ukwehla okukhulu kumanqaku e-VAS ye-0.44 ngeentsuku ezili-10 emva kwesiseko (p <0.001). Amanqaku esiseko asisiseko yayingu-5.34, 95% CI (4.47, 6.22). Uhlalutyo lweziphumo ezingahleliwe lubonakalise umahluko omkhulu kumanqaku esiseko (SD = 1.09). Njengoko ii-intercepts ezingahleliwe zihlala zisasazwa, oku kubonisa ukuba i-95% yezo ndlela ziphakathi kwe-3.16 kunye ne-7.52 enika ubungqina bokuba umahluko omkhulu kumaxabiso asisiseko kwizigulana. Amanqaku e-VAS aqhubeka ebonisa ukuphucula kwiqela leeveki ezingama-24 ezilandelelanayo (jonga umzobo 12).

 

 

 

Ukuphendula ngokucacileyo kwi-NUCCA ukungenelela kunye nokunyamekelwa okuxelwe zifundo ezilishumi kwakumnxeba omnene, ulinganise umlinganiselo wesithathu kwishumi ekuhloleni ubuhlungu. Kwizifundo ezintandathu, iintlungu zaqala ngaphezu kweeyure ezingamashumi amabini anesine emva kokulungiswa kwee-atlas, ezihlala ngaphezu kweeyure ezingamashumi amabini anesine. Akukho mbandela echazwe nayiphi na impembelelo ebalulekileyo kwimisebenzi yabo yemihla ngemihla. Zonke izifundo zivakalisa ukwaneliseka ngononophelo lwe-NUCCA emva kweveki enye, amanqaku aphakathi, ezilishumi, kwizinga elilinganiselwa kwishumi.

 

Insight of Dr. Alex Jimenez

“Kudala ndineminyaka ndiqaqanjelwa yintloko ebuhlungu. Ngaba sikhona isizathu sokuba iintlungu zentloko yam? Ndingenza ntoni ukunciphisa okanye ukususa iimpawu zam? ”Intloko ye-Migraine ikholelwa ukuba yinto edibeneyo yentlungu yentloko, nangona kunjalo, isizathu sokuba nabo bafana naluphi na uhlobo lwentloko. Ukulimala kabuhlungu kwintlambo yomlomo wesibeleko, njengokwenza i-whiplash kwingozi yemoto okanye ukulimala kwezemidlalo, kunokubangela ukuchithwa kakubi entanyeni nasemva ngasentla, oku kunokukhokelela ekuthandeni. Ukunyameka okungafanelekanga kunokubangela ukuba imiba yentamo ingakhokelela entlungu nasentanyeni yentlungu. Iingcali zonyango ezijongene nempilo yengqondo yomgudu zingakwazi ukuxilonga umthombo wakho weentloko ze-migraine. Ukongezelela, ochwepheshe abaqeqeshekileyo nabanobuchule banokwenza utshintsho lomgudu kunye neendlela zokunyanzelisa ukuba zilungise naluphi na ukungalunganga komgudu ongabangela iimpawu. Inqaku elilandelayo lishwankathela uphando lwesifundo olusekelwe kukuphuculwa kweempawu emva kokuhlaziywa kwe-atlas vertebrae kubathathi-nxaxheba abane-migraine.

 

ingxoxo

 

Kulo qela elilinganiselwe kwezifundo ezilishumi elinanye ze-migraine, bekungekho utshintsho oluphawulekayo kwi-ICCI (umphumo oyintloko) emva kokungenelela kwe-NUCCA. Nangona kunjalo, utshintsho oluphawulekayo kwiziphumo ezisesekondari ze-HRQL zenzeke ngokufingqiweyo kwiThebhile 5. Ukuhambelana nokuphakama nokuphucula kuzo zonke iinkqubo ze-HRQLL kubonisa ukuzithemba ekuphuculeni impilo yengqondo kwinyanga yesibini elandelayo emva kwexesha lexesha lexesha le-28.

 

 

Ngokusekelwe kwiziphumo zophando, olo uphando lucacisa ukwanda okukhulu kwi-ICCI emva kokuba ngoncedo lwe-atlas e ngazange igcinwe. Ukusetyenziswa kwe-PC-MRI kuvumela ukulingana kobudlelwane obuqilileyo phakathi kokungena kwe-arterial, ukuphuma kwe-venous, kunye nokuhamba kwe-CSF phakathi kwekratshi kunye nomgudu womgogodla [33]. Inkcazo yokuthobela i-Intracranial (ICCI) inokulinganisa ikhono lobuchopho lokuphendula igazi elingenayo igazi ngexesha le-syole. Ukuchazwa kwalo mqondiso ohambelanayo umelelwa ubuhlobo obuxhomekeke phakathi kwe-CSF kunye ne-CSF. Ngokuthotyelwa kwenyameko okanye ngaphezulu kwe-intracranial, kwakhona ichazwa njengendawo yokugcina i-compensatory blood reserve, igazi elingenayo igazi eliza kungeniswa yizinto ezingenakunyakalala kunye neenguqu ezincinci ekunyanzelekeni kokunyanzeliswa. Nangona utshintsho kwivolumu okanye ingcinezelo inokuthi yenzeke, ngokusekelwe kwimeko yokubonakalisa ubuhlobo bexinzelelo, ukutshintsha emva kokungenelela kwe-ICCI akunakwenzeka. Uhlalutyo oluphambili lweedatha le-MRI kunye nokufundwa okuqhubekayo kuyadingeka ukupakisha iiparamitha ezinokuthi zisebenzise njengenjongo ekujoliswe kuyo ekubhaliweyo kwenguqu ye-physiologic emva kokulungiswa kwee-atlas.

 

Koerte et al. Iingxelo zezigulana ezingapheliyo ezibonisa ukuba izigulane zihlala zibonakalisa isiqhelo esiphezulu esiphakamileyo semvula (i-plexus ye-paraspinal) kwindawo ephakamileyo xa kuthelekiswa nokulawulwa kweminyaka yobudala kunye nobulili [34]. Izifundo ezine zezifundo zibonise umjelo wesibini kunye nezo zintathu zezifundo ezibonisa ukunyuka okuphawulekayo kokuthotyelwa emva kokungenelela. Ukubaluleka akungaziwa ngaphandle kokufunda. Ngokufanayo, uPomschar et al. ingxelo yokuba izifundo ezinobungozi obunzima bentliziyo (mTBI) zibonisa umkhumbi okhulayo ngeendlela eziphambili ze-paraspinal [35]. Inkcazo yokuthobela i-intracranial ibonakala ihla kakhulu kwiqela le-MTBI xa kuthelekiswa nokulawula.

 

Olunye uhlobo lunokufumaneka xa kuthelekiswa nedatha ye-ICCI yocwaningo kwizifundo eziqhelekileyo ezichazwe kwangaphambili kunye nalabo abaneMTBI kuboniswe kwi-Figure 8 [5, 35]. Ukunciphisa inani elincinci lwezifundo ezifundwayo, ukubaluleka kwezi ziphumo ezifundwayo zi nokuba nazo malunga noPomschar et al. ahlale engaziwa, enikela kuphela ukucatshulwa kwamathuba okuhlola ngokuzayo. Oku kunzima nakakhulu ngenguqu ye-ICCI engahambelaniyo kwizifundo ezimbini ezilandelwa kwiiveki ze-24. Isifundo sesibini kunye nephethini yesibini yamanzi ibonisa ukuhla kwe-ICCI emva kokungenelela. Ulingo olukhulu olulawulwa yindawo ye-placebo kunye nesayizi yesampula esisemgangathweni yesisampula singabonisa ukutshintsha ngokucacileyo ukuguqulwa kwe-physiological change emva kokusetyenziswa kwenkqubo yokulungiswa kwe-NUCCA.

 

Amanyathelo akwa-HRQLL asetyenziselwa kwikliniki ukuvavanya ukuphumelela kwesicwangciso sonyango ukunciphisa intlungu kunye nokukhubazeka okuhlobene nokuphathwa kwentloko ye-migraine. Kulindeleke ukuba unyango olusebenzayo luphucula isigulane esaziwayo kubuhlungu nokukhubazeka okulinganiswe kwezi zixhobo. Zonke izinyathelo ze-HRQL kule ngxelo zibonise ukuphucula kunye nokuphucula okukhulu ngeveki ezine emva kokungenelela kwe-NUCCA. Ukususela ngeveki ezine ukuya kwiiveki ezisibhozo kuphela ukuphuculwa kwamancinci. Kwakhona, ukuphuculwa okuncinci kuphela kuphawuliwe kwizifundo ezimbini ezilandelwe kwiiveki ze-24. Nangona le ngxowa-mali yayingenjongo yokubonisa ukungenelela kwindlela yokungenelela kwe-NUCCA, iziphumo ze-HRQL zidala umdla wokunyusa ukuqhubela phambili.

 

Ukususela kwidayari yeentloko, ukwehla okukhulu kwiintsuku zentloko ngeenyanga kwaphawulwa kwiiveki ezine, phantse kabini kwiiveki ezisibhozo. Nangona kunjalo, ukungafani okubalulekileyo kwintloko yesisindo ngaphezu kwexesha kwakungaqondakali kule datha yedatha (jonga umfanekiso 5). Nangona inani leentloko liyehla, izifundo zisasetyenziswa ngamachiza ukugcina ubunzima beentloko kumanqanaba akhathazekayo; Kungoko, kuthethwa ukuba ukuhluka okubalulekayo kwintloko yesininzi akunakunqunywa. Ukubambisana kwimihla yamakhanda ekhanda lomlomo okwenzeka ngeveki ye-8 kwizifundo ezilandelelanayo kunokukhokelela ekugxilweni kwenkqubela ezayo ekuqaliseni ukuba uphuculo oluphezulu lwenzeka ntoni ukunceda ekumiseni umgangatho we-NUCCA wokunakekelwa kwe-migraine.

 

Utshintsho olufanelekileyo lwezonyango kwi-HIT-6 lubalulekile ekuqondeni ngokupheleleyo iziphumo eziqwalaselweyo. Utshintsho lweklinikhi olunentsingiselo kwisigulana ngasinye luchazwe sisikhokelo somsebenzisi weHIT-6 njengo? 5 [36]. UCoeytaux et al., Usebenzisa iindlela ezine zohlalutyo ezahlukeneyo, cebisa ukuba umahluko phakathi kweqela kumanqaku e-HIT-6 eiyunithi ze-2.3 ngokuhamba kwexesha unokuthathwa njengobalulekileyo ekliniki [37]. Unyale okqhubekayo. Ufundile ukhathalelo lokuqala lwe-migraine isigulana ekuphuhliseni iingcebiso ezicetyiswayo kusetyenziswa utshintsho lwamanqaku e-HIT-6 kukhathalelo lweklinikhi nophando [38]. Kuxhomekeka kwiziphumo ezibangelwe ziimposiso ezingezizo okanye izinto ezingalunganga, ngaphakathi komntu utshintsho oluncinci olubalulekileyo (MIC) kusetyenziswa 'indlela yenguqu' kuthelekelelwa ukuba ngamanqaku ayi-2.5. Xa usebenzisa i-cereceiver yokusebenza uphawu (ROC) yohlalutyo lomjikelo utshintsho olunamanqaku ama-6 luyafuneka. Kunconywe umahluko phakathi kweqela umahluko obalulekileyo (MID) ngu-1.5 [38].

 

Usebenzisa indlela yokutshintsha, zonke izifundo kodwa esinye sixele utshintsho (sinciphise) esikhulu kune-2.5. Uhlalutyo lwe-OCROC lukwabonisa ukuphuculwa kwazo zonke izifundo kodwa sinye. Esi 'sifundo sinye' yayingumntu owahlukileyo kuhlalutyo ngalunye. Ngokusekwe nguSmelt et al. Iikhrayitheriya, izifundo ezilandelelweyo ziyaqhubeka ukubonisa ngaphakathi-komntu ukuphuculwa kokubaluleka kokubonakalayo njengoko kubonisiwe kwi Umzobo 10.

 

Zonke izifundo kodwa zimbini zibonise ukuphuculwa kwinqanaba le-MIDAS phakathi kwesiseko kunye neziphumo zeenyanga ezintathu. Ubungakanani botshintsho babulingana namanqaku esiseko e-MIDAS, ngazo zonke izifundo kodwa zintathu zinika ingxelo ipesenti engamashumi amahlanu iyonke okanye utshintsho olukhulu. Izifundo ezilandelwayo ziyaqhubeka nokubonisa ukuphucuka njengoko kubonisiwe ekunciphiseni okuqhubekayo kwamanqaku ngeveki ye-24; Jonga amanani 11 (a) -11 (c).

 

Ukusetyenziswa kwe-HIT-6 kunye ne-MIDAS ndawonye njengesiphumo sekliniki kunokubonelela ngokuphonononga okupheleleyo kwezinto zokukhubazeka ezinxulumene nentloko (39]. Ukwahluke phakathi kwezikali zombini kunokuqikelela ukukhubazeka kwintlungu yesifo intlungu kunye nobuhlungu beentloko, ngokubonelela ngolwazi oluninzi malunga nezinto ezinxulumene nezinguqu ezichaziweyo ngaphandle kwesiphumo esisetyenzisiweyo yodwa. Nangona i-MIDAS ibonakala iguqula ngaphezulu ngeenyawo zentloko, ubukhulu beentloko bubonakala buchaphazela amanqaku eHIT-6 ngaphezu kwe-MIDAS [39].

 

Indlela i-migraine entloko ithinte ngayo kwaye imida yesigidi esibhekwayo yokusebenza imihla ngemihla ixelwa yi-MSQL v. 2.1, kwiimimandla ezintathu ze-3: indima yokuthintela (MSQL-R), indima yokukhusela (MSQL-P), kunye nokusebenza ngokomzwelo (MSQL-E). Ukwandiswa kwamanqaku kubonisa ukuphucula kule mimandla ngexabiso elivela kwi-0 (ihlwempu) ukuya kwi-100 (engcono).

 

Uvavanyo lokuthembeka kwesikali seMSQL nguBagley et al. ingxelo zeziphumo zokumodareyitha zinxulunyaniswe kakhulu ne-HIT-6 (r =? 0.60 kuye? 0.71) [40]. Isifundo nguCole et al. inika ingxelo ngumahluko obalulekileyo (MID) utshintsho lweklinikhi kwisizinda ngasinye: MSQL-R = 3.2, MSQL-P = 4.6, kunye neMSQL-E = 7.5 [41]. Iziphumo ezivela kwingxelo yophando lwe-topiramate ingxelo yeklinikhi (MIC) utshintsho oluthile: I-MSQL-R = 10.9, i-MSQL-P = 8.3, kunye ne-MSQL-E = 12.2 [42].

 

Zonke izifundo ngaphandle komntu onolwazi oluthile oluthile olubalulekileyo olutshintsho lwekliniki lwe-MSQL-R olukhulu kune-10.9 ngokulandelwa kweveki-ezisibhozo kwi-MSQL-R. Zonke izifundo zimbini zichaze utshintsho lwamaqela angaphezulu kwe-12.2 kwi-MSQL-E. Ukuphuculwa kwimiba ye-MSQL-P kwandiswe ngamanqaku ashumi okanye ngaphezulu kuzo zonke izifundo.

 

Uhlalutyo lokunciphisa uvavanyo lwe-VAS ngokuhamba kwesikhathi lubonakalise ukuphuculwa okubalulekileyo kwinyanga ye-3. Kwakukho uguquko oluninzi kumanqanaba okuqala kuwo onke izigulane. Kancinci ukungafani kwaye kwabonakala kwinqanaba lokuphucula. Olu hlobo lubonakala lufanayo kwizifundo ezifundwa kwiiveki ze-24 njengoko kuboniswe kwi-Figure 12.

 

 

Izifundo ezininzi usebenzisa ukungenelela kwemithi zibonise i-placebo enamandla kwizigulane ezivela kubantu abafudukayo [43]. Ukuqulunqa ukuphuculiswa kwemigudu engaphezu kweenyanga ezintandathu, ukusebenzisa enye ingenelelo kunye nokungena nongenelelo, kubalulekile ukuba kukho nawuphi na ukuthelekiswa kweziphumo. Uphando kwiimpembelelo ze-placebo ngokuqhelekileyo uyamkela ukuba ukungenelela kwendawo ye-placebo kunika uncedo olusisigxina kodwa aluguquli iinkqubo zepathophysiologic phantsi kwesi simo [44]. Iinjongo ze-MRI zinokukunceda ekutyhileni umphumo onjalo we-placebo ngokubonisa utshintsho kwimilinganiselo ye-physiologic yokupakisha kweeramitha ezenzeka emva kokungenelela kwe-placebo.

 

Ukusetyenziswa kweempawu ezintathu ze-MRI ukuqokelela ulwazi lwe-MRI kuza kukwandisa ukunyaniseka kwemilinganiselo ngokunyusa inani leenkcukacha ezisetyenziselwa ukubala nokubala kwe-ICCI. Le ngenye yophando lokuqala ngokusebenzisa utshintsho kwi-ICCI njengesiphumo ekuvavanyeni ukungenelela. Oku kudala imingeni ekuchazeni i-MRI ifumaneke iinkcukacha ukusekela izigqibo okanye ukuphuhliswa kwengqondo. Ukuhlukahluka kobudlelwane phakathi kokuphuma kwegazi ukuya nakubomi, ukugeleza kwe-CSF, kunye nokulinganisa kwenhliziyo yale parameters ethile yenkalo kuye kwabikwa [45]. Utshintsho oluboniswe kumanyathelo amancinci aphindaphindiweyo amathathu okufundisisa luye lwaholela kwizigqibo zokuba ulwazi oluqokelelwe kwiimeko ezithile luguqulelwe ngokulumkisa [46].

 

Uncwadi luye lwaqhubeka nokunika ingxelo kwizifundo ezikhulu ezinokuthenjwa ekuqokeleleni le MRI ifumene idatha yokuhamba kwevolumetric. IWentland okqhubekayo. uxele ukuba imilinganiselo ye-CSF velocities kumavolontiya abantu kunye ne-sinusoidally eguquguqukayo ye-phantom velocities khange yahluke kakhulu phakathi kweendlela ezimbini ze-MRI ezisetyenzisiweyo [47]. UKoerte et al. Ufundile amaqela amabini ezifundo ezinomfanekiso kumaziko amabini ahlukeneyo anezixhobo ezahlukeneyo. Baxela ukuba ii-coefficients zokulungelelaniswa kwe-intraclass (ICC) ibonakalise ukuthembeka okuphezulu kwangaphakathi kunye nokungenelela kwe-PC-MRI yevolumetric yokuhamba kwenqanaba lokulinganisa okushiyekileyo elizimeleyo kwizixhobo ezisetyenzisiweyo kunye nenqanaba lesakhono somqhubi [48]. Ngelixa umahluko we-anatomic ukhona phakathi kwezifundo, awuzange uthintele uphononongo lwabantu abaninzi ekuchazeni iiparameter zokuphuma okungafaniyo [49, 50].

 

Ukusekelwe kuphela kwisigulana sengqondo ngokuzimela, kukho ukulinganiselwa ekusebenziseni iziphumo ezichazwe ngesigulane [51]. Nayiphi na into echaphazela ingcamango yesifundo kwimpumelelo yobomi inokuchaphazela isiphumo sawo nawuphi na uvavanyo olusetyenziswayo. Ukungabikho kwesiphumo esithile kwimpawu zokunika ingxelo, iimvakalelo kunye nokukhubazeka kunciphisa ukuchazwa kweziphumo [51].

 

Ukujonga kunye nokuhlaziywa kwedatha ye-MRI iindleko zokusetyenziswa kakubi kweqela lokulawula, ukunciphisa naziphi na iziphumo ezikhoyo. Ubukhulu beesampula obukhulu buya kuvumela izigqibo ngokusekelwe kumandla okubala kunye nokunciphisa Iphutha lohlobo. Ukuchazwa kwanoma luphi na ukubaluleka kwezi ziphumo, ngelixa utyhila imimandla enokwenzeka, uhlala ucingisisa. Inkulu engaziwayo iyaqhubeka nokuba kunokwenzeka ukuba olu tshintsho luhlobene nokungenelela okanye kwenye into eyenziwa ngabaphenyi. Ezi ziphumo zidibanisa emzimbeni wolwazi lwangaphambili olungabonakaliyo olutshintsho lwe-hemodynamic kunye ne-hydrodynamic emva kokungenelela kwe-NUCCA, kwakunye neenguqu kwi-migraine i-HRQoL yesigulane esichaze iziphumo njengoko zibonwe kule nkalo.

 

Ixabiso leenkcukacha eziqokelelwayo kunye nokuhlalutya kunika ulwazi olufunekayo ekuqikelelwa kwimizekelo yesifundo esicwangcisiweyo kwisifundo esilandelayo. Imingeni yokulungiswa kwenkqubo yokuqhuba umqhubi uyavumela inkqubo ecacisiweyo yokuphumeza lo msebenzi.

 

Kule sifundo, ukungabi nenyuka ngokukhawuleza kokuthotyelwa kungaqondwa yi-logarithmic kunye nesimo esinamandla sokuhamba kwe-hemodynamic kunye ne-hydrodynamic, ukuvumela ukuba izakhi ezithile zibandakanye ukuthotyelwa kokutshintsha xa kungenjalo. Ukungenelela ngempumelelo kufuneka kuphuculwe isifundo esicatshulwa intlungu kunye nokukhubazeka ezihlobene nokugqithiswa kwentloko njengoko kulinganiswe ngala mafutha ase-HRQL asetyenziswayo. Ezi ziphumo zophando zibonisa ukuba ukungenelela kwe-atlas ukungenelelo kungabandakanywa nokunciphisa imvama ye-migraine, ukuphuculwa okuphawulekayo kumgangatho wobomi obangela ukunciphisa okubonakalayo ekukhubazekeni okuchaphazelekayo kwentloko njengoko kubonwe kulolu qela. Ukuphuculwa kweziphumo ze-HRQLL kubangela inxaxheba enyanzelisayo yokuqhubela phambili ukufunda, ukuqinisekisa ezi ziphumo, ngokukodwa kwiziko elikhulu lokufunda kunye neqela le-placebo.

 

Imibulelo

 

Ababhali bayamkela uDkt Noam Alperin, Alperin Diagnostics, Inc., Miami, FL; UK Kathy Waters, uMququzeleli woFundo kunye noDkt. Jordan Ausmus, uMququzeleli weeRadioography, iBritannia Clinic, eCalgary, AB; Sue Curtis, uMRI Technologist, uEliot Fong Wallace Radiology, Calgary, AB; kunye noBrenda Kelly-Besler, uRN, uMququzeleli woPhando, iNkqubo yoVavanyo lweNtloko kunye neCandelo loLawulo (CHAMP), Calgary, AB. Inkxaso yemali inikezelwa yi-1) iHecht Foundation, iVancouver, BC; (2) iTao Foundation, Calgary, AB; (3) URalph R. Gregory Memorial Foundation (Canada), Calgary, AB; kunye (4) Isiseko sePhando loPhando lwesibeleko (i-UCRF), iMinneapolis, MN.

 

izifinyezo

 

• I-ASC: I-Atlas i-subluxation complex
• I-CHAMP: I-Calgary yoHlolo lweNtloko kunye noLawulo lweNkqubo
• CSF: I-Cerebrospinal Fluid
• IGSA: I-Analyzer Stress Analyzer
• I-HIT-6: Uvavanyo lwe-Headache Impact Test-6
• I-HRQoL: Umgangatho ofanelekileyo wezeMpilo
• ICCI: Inkcazo yokuthobela i-Intracranial
• I-ICVC: Utshintsho lwevolumu ye-Intracranial
• IQR: Udidi lwe-Interquartile
• I-MIDAS: I-Migraine Assessment Disability Scale
• I-MSQL: I-Quality-Specific Quality of Life Measure
• I-MSQL-E: I-Quality Migraine-Quality Specific of Life Measure-Emotional
• MSQL-P: I-Quality-Specific Quality of Life Measure-Physical
• MSQL-R: I-Quality-Specific Quality of Life Measure-Restrictive
• I-NUCCA: UMbutho weSizwe ophezulu weCervical Chiropractic Association
• I-PC-MRI: IsiGaba sokuBoniswa kweMiboniselo yokuHlaziya kweMagnetic
• I-SLC: I-Supine Leg Hlola
• I-VAS: I-Analog Scale.

 

Ulwaphulo lomdla

 

Ababhali bhengeza ukuba akukho mali okanye nayiphi na into enokubambisana ngokupapashwa kweli phepha.

 

Igalelo labalobi

 

H. UCharles Woodfield III wathatha isifundo, wasinceda ekwakheni kwakhe, wancediswa ekusebenzisaneni, kwaye wanceda ukuqulunqa iphepha: isingeniso, iindlela zokufunda, iziphumo, ingxoxo kunye nesiphetho. UDkt. Gordon Hasick uhlolwe izifundo zokufunda / ukukhutshwa, ukunikezelwa ngoncedo lweNUCCA, kunye nokuhlola zonke izifundo ngokulandelelana. Uthathe inxaxheba ekuqulunqweni kokufunda kunye nokuququzelela umxholo, ukuncedisa ukuqulunqa iNkulumkiso, iindlela zeNUCCA kunye neNgxoxo kwiphepha. UWerner J. Becker uhlolwe izifundo zokufunda / ukungabikho, uthatha inxaxheba ekufundzeni nokucwangciswa, kwaye wancedisa ukuqulunqa iphepha: iindlela zokufunda, iziphumo kunye nengxoxo kunye nesiphelo. UMarianne S. Rose wenza uhlalutyo lwamanani kwiinkcukacha zophando kwaye wancedisa ukuqulunqa iphepha: iindlela zokubala, iziphumo kunye nengxoxo. UJames N. Scott uthathe inxaxheba kwisicwangciso sokufunda, waba ngumcebisi we-imaging uhlalutya izicatshulwa zokugula, kwaye wancedisa ukuqulunqa iphepha: iindlela ze-PC-MRI, iziphumo kunye nengxoxo. Bonke abalobi bafunde kwaye bavumile iphepha lokugqibela.

 

Ukuququmbela, Ucwaningo lwesifundo malunga nokuphuculwa kweempawu zeentloko ze-migraine emva kokuhlaziywa kwe-atlas vertebrae kuboniswe ukwanda kwiphumo eliphambili, nangona kunjalo, iziphumo eziqhelekileyo zophando zophando azibonisi niselo kubalo. Konke, uphando lwalo lugqiba ukuba izigulane ezithe zafumana unyango lwama-atlas vertebrae zonyango ziphuculwe kakhulu kwiimpawu kunye nokuhla kweentsuku zamakhanda. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

 

Imixholo eyongezelelweyo: Intlungu Yentambo

 

Intlungu yesikhumba isishalazo esiqhelekileyo esinokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokwezibalo, ukulimala kwengozi yemoto kunye nokulimala kwe-whiplash zizinye zezona zinto zixhaphake iintlungu phakathi kwabantu bonke. Ngethuba lengozi yengozi, igalelo elizenzekelayo elivela kweso siganeko kunokubangela ukuba intloko nentamo iqhume ngokukhawuleza emva kwanoma iyiphi na indlela, eyonakalise izakhiwo eziyinkimbinkimbi ezungeze umgudu wesibeleko. Ixinzelelo kumathambo kunye nemigqa, kunye neyezinye izicubu entanyeni, kunokubangela iintlungu zentamo kunye nokubonakalisa imiqondiso emzimbeni womntu.

 

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

 

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