Hello everyone. For those of you who don't know me, my name is Andrew Nguyen. I'm a fourth year osteopathic medical student from Toro College of Osteopathic Medicine in Middletown, New York. Now I'm on here on behalf of the rest of the Toro team to discuss our project on the effects of state-trained anxiety on the thoracic diagram and related fascias. So we can just go in depth here right now. So we know that osteopathic medicine seeks to explore the specific structures involved in disease pathology through their associated semantic dysfunctions. So one of the most important structures of interest is the fascia and its connection with the neuromuscular skeletal system. So the fascia is a huge sheath of continuous connective tissue that permeates every organ, the nerves, the muscles, the bones, blood vessels, everywhere throughout the body. And so it's very connected in regards to every other structure that's involved from point A to point B. So there have been multiple studies that we've looked at that have shown that the fascia's influence in regulating the hypothalamic pituitary axis and autonomic nervous system, and that any sort of dysfunction in the fascia can influence those systems consequentially. So when it comes to neuropsychiatric health, we're trying to see how the influence of fascia and its surrounding structures can specifically impact different types of anxiety in medical students, two of them being state and trained anxiety. So state anxiety is the proclivity of one to perceive a situation as threatening and transiently experience apprehension, tension, and dread. And this is all usually kind of in one set point in time. Now trained anxiety is a stable inclination to experience state anxiety to varying external stimuli, but this is usually kind of on a continuum, meaning how likely are you inclined to have that throughout your life. And so this study specifically examined how anxiety manifests in the somatic dysfunctions of medical students. And we do so by comparing osteopathic structural exam findings to scores taken from the state trait inventory for cognitive and somatic anxiety. So that's essentially the abbreviated as STICSA. The STICSA questionnaire is a way that we quantify that. So in terms of materials and methods, there was approximately 200 four-year college medical students from the Harlem and Middletown and the Montana campuses, and they all completed the STICSA survey. And afterwards, they underwent a subsequent osteopathic structural exam that was conducted by medical student investigators such as myself. And so during that process, we were able to quantify the presence and severity of somatic dysfunctions within these exams using a scale of zero to two. So zero is no somatic dysfunction, one is a presence and it's kind of mild, and two is a presence and it's usually moderate to severe. And these were all assessed using the following criteria of TART changes, which we all know since the first year of medical school, tissue texture changes, asymmetries, altered ranges of motion, and tenderness. And through these specific structures that we examined, we kind of tackled more on the structures that are involved with anxiety symptoms like chest pain, chest tightness, shortness of breath, headaches, and so forth. So we examined things like the OM suture, the OA joint, the cervical cladomastoid, the ribs, obviously the thoracic inlet for its association with the fascia, the thoracic diaphragm, and the list goes on. So numerical scores were collected from that STICSA, and they're correlated with the structural exam findings with that quantification, the results of that. And so they're analyzed using a Pearson's coefficient. So data was later stratified to compare selected thoracic structures, and their correlation with the STICSA surveys kind of divided into their somatic and cognitive components as well. So as you can see here in the results in the middle of the page, we see that there seems to be a significant positive correlation in regards to the total somatic dysfunctions, the total severity in the somatic dysfunctions, and all of that kind of plotted with state cognitive and somatic anxiety among these medical students. So just to go really brief, cognitive is more so how are you feeling mentally? So are you nervous? Are you anxious? And so forth. Meanwhile, somatic is are you short of breath? Do you develop chest pain? And so through all those, those were all quantified and then correlated to the structural exam findings. So we did see some significant results across all three campuses, which is really interesting. However, we didn't really see anything in regards to trait. So if you can see here in the bottom figures, with the correlation matrix on the left, that in all red and blue and white, that this is kind of a way to kind of stratify all the structures that we're examining, and how does that correlate with the state cognitive somatic and the trait cognitive and somatic anxiety components. And you can see here in the subsequent chart on the right side labeled B, we kind of plotted all the P values indicating which one is actually statistically significant. And to kind of just go more in depth with there in terms of the discussion on the right side, we ultimately found that the thoracic inlet, thoracic spine, vertebrae, they all held statistical significance and positive correlations in regards to somatic dysfunction totals and state anxiety totals. Same thing goes for, again, the thoracic inlet of the thoracic spine with state cognitive anxiety sticks of totals. So these were all very interesting. But again, we didn't really find anything in regards to trait anxiety. There could be a lot of things that could be at play for some reason, one of them being that we're all medical student investigators who were conducting the exam. So in terms of the skill, it could be lacking. There could also be a matter of, you know, trait anxiety is more of a continuum. So maybe if we were to assess these people throughout medical school rather than a set point in time, we'd most likely get some different results. But these are all something to make note of and take into consideration as we go through the rest of our studies. So nonetheless, I believe this really shows how interesting this topic is because we've seen a lot of other studies that are very relevant towards it. You know, one of our principal investigators, one of our medical student investigators are conducting a PTSD and somatic dysfunction study. So very, very similar, but it looks like it's more specified towards a specific population. And then one of our faculty members at Toro actually recently published a paper on treatment of osteopathic somatic dysfunctions and how does that kind of affect the anxiety levels that patients are experiencing. So there's a lot of different things at play that we can further expand upon. But ultimately, we see that this is a great gateway for us to kind of determine better ways we can better holistically treat our patients, the more it's a personal cost effective and sustainable modalities for osteopathic medicine. So I believe that concludes my presentation. If you have any questions, please don't hesitate to reach out. Thank you so much.

osteopathic medicine

state-trait anxiety

thoracic diaphragm

somatic dysfunctions

fascias