Radiation therapy remains an essential component of cancer treatment, with nearly 50% of cancer patients receiving radiation therapy at some point during the course of their illness. Of those, the vast majority experience some form of acute radiation dermatitis (ARD) or radiation-induced skin injury. ARD results in significant discomfort, restriction of daily activities, overall decrease in the quality of life and even cessation of the necessary radiation therapy with detrimental survival effects. Unfortunately, research into the causes and possible management strategies for ARD is hindered by the lack of biomarkers for the quantitative assessment of the early changes associated with the condition. This study provides the basis to identify low grade ARD, using Optical Coherence Tomography (OCT) images with the extraction of conventional image intensity and novel features. Twenty-two patients were imaged twice each week until the end of their radiation treatment resulting in 1487 images. The severity of the cases was graded by an expert oncologist. The preliminary results of various machine learning (ML) classifiers have shown that an LDA based approach provided the best performance, separating normal skin from very early ARD, with an accuracy of 85%.
Background
Neuromodulation (NM) is a family of therapies based on electrical stimulation to target specific nerves that control LUTS (Lower Urinary Tract Symptoms) and pain. The aim is to modulate what is happening within the nervous system to achieve therapeutic effects. A particular type of neuromodulation, called TENS (Transcutaneous Electrical Nerve Stimulation), has proven effective for treating pelvic pain. The available evidence provides indications regarding the many aspects of TENS that influence therapeutic effects, but a comprehensive review has yet to be conducted.
Methods
Scoping review on Pubmed, CINAHL, Embase, Scopus, and Web of Science, including clinical trials, reviews, case studies or series, and other descriptive studies, according to the Joanna Briggs and PRISMA methodology.
Results
The 31 papers retrieved allowed the formulation of precise indications about the DOs and DON'Ts of electrode placement, waveform, pulse duration, pulse frequency, amplitude, session duration, and frequency of sessions. This paper also discusses the biochemical and neuro urological mechanisms of TENS.
Conclusion
TENS effectiveness is influenced by many factors, some self‐evident, others subtle, which this paper elucidates. Pelvic pain requires a multimodal approach, of which TENS is just a part. TENS should therefore be viewed as one of the components of the rehabilitation program in the frame of thorough and continuous patient assessment.
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