The effectiveness of vibration therapy for muscle peak torque and postural control in individuals with anterior cruciate ligament reconstruction: a systematic review and meta-analysis of clinical trials.

OBJECTIVE: This study aimed to review and summarize the existing evidence on the effectiveness of vibration therapy (VT) in comparison with conventional rehabilitation in anterior cruciate ligament (ACL)-reconstructed patients considering muscle peak torque and postural control. METHODS: We searched available online databases for relevant studies published up to February 2020. All randomized clinical trials investigating the effect of VT on quadriceps peak torque, hamstring peak torque, and postural control (closed-eye and open-eye) were included. Overall, 13 clinical trials with a total sample size of 407 participants were included for the meta-analysis. We used the pooled mean difference with random effects model for meta-analyses. We assessed the heterogeneity of the studies using the I2 and Cochran's Q test. Meta-regression analysis was used to assess the source of heterogeneity. RESULTS: We found that VT significantly improved hamstring peak torque [weighted mean difference (WMD) 12.67, 95% CI 4.51-20.83] and quadriceps peak torque (WMD 0.11, 95% CI -0.06 to 0.29). However, subgroup analysis showed a significant increase in mentioned muscles' peak torque in studies employing interventions including both local muscle vibration (LMV) and vibration frequency higher than 100 Hz (WMD 20.84, 95% CI 11.75-29.93). With regard to postural control, we observed a significant improvement only in open-eye mediolateral postural control (WMD 0.26, 95% CI -1.26 to 1.77). CONCLUSION: This study suggests that VT, especially LMV type with vibration frequency higher than 100 Hz, can be effective in rehabilitation of ACL-reconstructed patients. Although improvement in the peak torque of hamstring and quadriceps muscles was seen, there was no significant improvement in postural control, especially closed-eye, in comparison with conventional rehabilitation. LEVEL OF EVIDENCE: 1. HIGHLIGHTS: Vibration therapy can increase hamstring peak torque in individuals with ACL reconstruction. Local muscle vibration type in comparison with whole-body vibration is recommended for ACL-reconstructed patients. Vibration frequency higher than 100 Hz is preferred in ACL-reconstructed rehabilitation.

Liver fat content might be an appropriate measure for estimation of cardiovascular disease risk in non-alcoholic steatohepatitis patients.

Background: Non-alcoholic steatohepatitis (NASH) is increasing worldwide due to the metabolic syndrome epidemy. According to the current evidence, a higher cardiovascular disease risk (CVDR) is observed in NASH individuals than the general population. Objective: The relationship between liver fat content (LFC) and CVDR in a cohort of NASH patients was evaluated in this research. Methods: Consecutively selected patients with increased aminotransferase levels and fatty change in liver ultrasonography were enrolled in the study. Those with known causes of viral hepatitis, any hepatotoxic medications or alcohol consumption, autoimmune hepatitis, cigarette smoking, and ischemic heart disease were excluded from the project. The remaining was presumed to have NASH. The Framingham risk score (FRS) and LFC were calculated by means of an online calculator and a valid formula, respectively. The correlation between LFC and independent variables was measured using the Pearson correlation test. The P-value of less than 0.05 was considered significant. The statistical analysis was performed using SPSS program version 18. Results: Finally, two hundred NASH patients were included in the study. Considering diabetes mellitus as a confounder, there was a fair relationship between LFC and FRS (R=0.26 and 0.23, respectively, p<0.05) in the second and third visits. Even after adjustment for known cardiovascular risk factors, LFC was associated with increased CVDR (OR=9.181; 95% CI: 2.00-42.14, p=0.01). The cut-off value of 9.1% for LFC had a sensitivity of 92% and a specificity of 87% for discrimination of the FRS >20% and <20%. Conclusion: LFC might independently be correlated with CVDR in NASH patients. If further research confirmed this relationship, the inclusion of LFC into the FRS formula would provide an appropriate CVDR estimation tool in NASH.

Dual peer mentoring program for undergraduate medical students: exploring the perceptions of mentors and mentees.

Background: Despite the advantages of dual peer mentoring, there are a few reports of implementing and evaluating such programs for medical students. This study aimed at exploring the perceptions of mentors and mentees about the dual peer mentoring program for the first year undergraduate medical students of Tehran University of Medical Sciences. Methods: This qualitative study was conducted at the end of the first year of implementing the mentoring program. All mentees and mentors were invited to participate in focus group discussions. Data were analyzed using a qualitative content analysis. Results: All mentors (n= 12) and a group of mentees (n= 21) participated in focus group discussion sessions. We provided a variety of supports for the mentees including academic and psychosocial support and positive relationship; as a result, some developments occurred to the mentors We also explored participants' views on some unique aspects of the program such as student-authorized, dual mentoring, and role model sessions. Conclusion: Our participants found the mentoring program beneficial in various academic achievements and psychosocial supports for both the mentors and the mentees. Dual peer mentoring program can be an alternative to school administered programs.

Regional fat distribution and hepatic fibrosis and steatosis severity in patients with nonalcoholic fatty liver disease and type 2 diabetes.

Background: Epidemiologic findings suggest that measures of body fat distribution predict health outcomes independent of the overall body fat assessed by body mass index (BMI). This study aimed to evaluate the associations of overall and regional body fat with the severity of hepatic steatosis and fibrosis in type 2 diabetic patients with non-alcoholic fatty liver disease. Methods: Bioelectric impedance analysis and two newly developed anthropometric indices, namely, A Body Shape Index (ABSI) and Body Roundness Index (BRI), were used to estimate the body fat. Based on fibroscan parameters, significant hepatic fibrosis and severe steatosis were defined as ≥F2 and >66%, respectively. Results: Higher total body fat (odds ratio [OR] 1.107, 95% confidence intervals (CI) 1.038-1.182, p = 0.002), trunk fat (OR 1.136, 95% CI 1.034-1.248, p = 0.008) and leg fat (OR 1.381, 95% CI 1.139-1.674, p = 0.001) were associated with liver fibrosis. However, in contrast to the total body fat (OR 1.088, 95% CI 1.017-1.164, p = 0.014) and leg fat (OR 1.317, 95% CI 1.066-1.628, p = 0.011), the trunk fat was not associated with severe hepatic steatosis. BRI performed better than trunk, leg and total body fat in predicting hepatic steatosis (OR 2.186, 95% CI 1.370-3.487, p = 0.001) and fibrosis (OR 2.132, 95% CI 1.419-3.204, p < 0.001). Moreover, the trunk to leg fat ratio and ABSI were not independent predictors of either steatosis or fibrosis (p > 0.05). Conclusion: BRI revealed a superior predictive ability for identifying the degree of hepatic steatosis and stiffness than other obesity indices. Additionally, higher levels of adiposity in the trunk, legs, and overall body were linked to an increased risk of developing liver fibrosis. Although trunk fat did not show an association with severe hepatic steatosis, an increase in leg and total fat was related to liver steatosis.

Burnout and clinical learning environment among residents in Tehran: A cross-sectional study.

PURPOSE: This study aimed to evaluate the quality of the educational environment in Tehran University of Medical Sciences across different medical specialties and its correlation with residents' burnout. MATERIALS AND METHODS: This cross-sectional study was conducted at Tehran University of Medical Sciences among residents drawn from three largest teaching hospitals affiliated. The Maslach Burnout Inventory and Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire were used to collect data through web-based, as well as paper-and pencil questionnaires. The data was analyzed using SPSS. RESULTS: A total of 221 residents completed the survey, with a response rate of 82%. Burnout was reported by 67.4% of medical residents. The total PHEEM score had a negative correlation with emotional exhaustion (r = - 0.57, P < 0.001), depersonalization (r = - 0.40, P < 0.001), and a positive one with personal accomplishment (r = 0.42, P < 0.001). Perception of social support significantly predicted burnout subscales (P < 0.05). PHEEM subscales also explained a small proportion of variance in emotional exhaustion (R = 0.55, R2 = 0.308, P < .001). Clinical learning environment independent of personal characteristics was associated with residents' burnout according to multivariate regression analysis [OR = 0.567 (0.170-0.883), P = 0.012]. CONCLUSION: Clinical learning environment independent of personal characteristics was associated with residents' burnout in Iran. We suggest some initiatives to be introduced ranging from improving the clinical environments, reduce workloads and provide social support to all residents as well as encouraging them to involve in other extracurricular activities like music and physical exercise.

Relationship Between Mentor Retention and the Role of Personality: A Descriptive-Analytical Study.

PURPOSE: According to the nature of mentoring, losing mentors reduces a program's capacity and causes a waste of resources to recruit, screen, and train new mentors. The purpose of this study was to assess the relationship between personality traits and retention intention among mentors and also the duration of mentor retention. METHODS: This is a descriptive-analytical study conducted at Tehran University of Medical Sciences. To assess relationship of mentor retention with their personality traits, one hundred forty mentors were surveyed. Participants were surveyed using the Temperament and Character Inventory. We used independent t-test, Pearson correlation and regression analysis with SPSS version 20. RESULTS: The response rate was 70%; of 98 respondents, 30.6% were male. There was a significant mean difference for self-transcendence and self-directedness traits with the mentors' intention to retention, respectively (t= 1.672, p =0.046 and t= 2.761, p =0.011). Furthermore, novelty seeking and self-directedness traits significantly predicted the mentor's intention to retention [OR=5.583 (1.656-18.826), 5.284 (1.310-21.309); respectively]. CONCLUSION: According to findings, the improved mentor's attitudes to retain in program may, therefore, be explained by an increase in mentors' self-directedness and novelty-seeking traits. Policy maker and educational managers should renew the process of recruitment of mentors and introduce supportive strategies every year to retain mentors, which can contribute to their retention.