Prone Single Position Approach to Lateral Lumbar Interbody Fusion: Systematic Review and Meta-Analysis.

BACKGROUND: Lateral lumbar interbody fusion (LLIF) with posterior screw fusion is a safe and effective treatment for patients suffering from degenerative spine disorders. While LLIF has been shown to restore disc height, decompress neural components, correct sagittal imbalances, and improve pain scores, the approach requires repositioning patients for posterior pedicle fixation, which requires 2 separate surgeries. The evolution of surgical techniques, navigation, and robotics has allowed for a single position approach to LLIF with the patient in the prone position. The purpose of this study was to perform a systematic review and meta-analysis comparing the prone single position (PSP) LLIF approach to the dual position LLIF approach. We hypothesized that PSP LLIF will have a reduced operative time, complication rate, and blood loss compared with the dual position LLIF procedure. METHODS: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed and Embase databases were searched with key terms: (lateral AND [interbody OR "inter body"] AND lumbar AND fusion) AND (prone OR single). Results were extracted and reviewed by 2 authors (MR and RB) per selection criteria. Patient demographics were extracted from the selected studies, along with surgical, patient-reported, and radiographic outcomes. A meta-analysis was performed using an unstandardized mean difference or log odds ratio with a confidence level of 95%. RESULTS: Fifteen studies were included in the systematic review and 5 studies compared PSP LLIF to dual position LLIF for meta-analysis. PSP LLIF had a reduced operative time and length of stay compared with the dual position approach, although there was no significant reduction in estimated blood loss. Additionally, PSP LLIF improved lumbar lordosis more effectively than dual position LLIF. There was no difference in segmental lordosis or pelvic tilt. There was no difference in intraoperative complications, postoperative complications, or reoperations. CONCLUSIONS: PSP LLIF reduces operative time and length of stay, with no relative increase in complications or reoperations compared with the dual position approach. Additionally, PSP LLIF improves lumbar lordosis relative to dual position LLIF, which may improve functional outcomes and reduce the risk of developing adjacent segment disease. CLINICAL RELEVANCE: The associated operative and postoperative benefits of PSP LLIF may improve long-term outcomes of patients undergoing spinal fusion.

Relationship between somatosensory and visuo-perceptual impairments and motor functions in adults with hemiparetic cerebral palsy.

Introduction: Children with cerebral palsy (CP) exhibit a variety of sensory impairments that can interfere with motor performance, but how these impairments persist into adulthood needs further investigation. The objective of this study was to describe the sensory impairments in adults having CP and how they relate to motor impairments. Methods: Nineteen adults having CP performed a set of robotic and clinical assessments. These assessments were targeting different sensory functions and motor functions (bilateral and unilateral tasks). Frequency of each type of impairments was determined by comparing individual results to normative data. Association between the sensory and motor impairments was assessed with Spearman correlation coefficient. Results: Impairment in stereognosis was the most frequent, affecting 57.9% of participants. Although less frequently impaired (26.3%), tactile discrimination was associated with all the motor tasks (unilateral and bilateral, either robotic or clinical). Performance in robotic motor assessments was more frequently associated with sensory impairments than with clinical assessments. Finally, sensory impairments were not more closely associated with bilateral tasks than with unilateral tasks. Discussion: Somatosensory and visuo-perceptual impairments are frequent among adults with CP, with 84.2% showing impairments in at least one sensory function. These sensory impairments show a moderate association with motor impairments.

Gingival health and relapse tendency: a split mouth randomized controlled trial of two positions of lower fixed retainers.

OBJECTIVE: To compare between lower permanent retainers placed in the middle of the incisal third and retainers placed in the middle of lower incisors in terms of gingival condition, lower incisors stability and retainers' failure rate. MATERIALS AND METHODS: This is a split-mouth clinical trial. Fifty patients finished fixed orthodontic treatment and required fixed permanent retainer in the lower arch were recruited. A multistranded (0.0215 inch) retainer, with a vertical step in the midline placing half of the retainer in the incisal third and the other half in the middle of the lower incisors was attached to all the teeth in the lower labial segment. After one year, all the subjects were recalled. The primary outcome was to evaluate the plaque index (PI) and the gingival index (GI) of the lower labial segment teeth. The secondary outcome was to assess retainers' failure rate and the relapse in lower labial segment alignment. RESULTS: The GI and the PI scores were significantly smaller on the side where the retainer was placed incisally (P = 0.004, P < 0.001, respectively). There was no statistical difference in the average Irregularity Index (IRI) and the retainer's failure rate between the two sides (P = 0.52, P = 0.76, respectively). CONCLUSION: Placing lower fixed retainers in the incisal third will improve the lower labial segment oral hygiene and gingival health in the lingual area without affecting the efficiency or the integrity of the retainers. This trial was not registered Null Hypothesis: Placing the lower permanent retainer in the middle of the lingual surfaces of the lower labial segment' teeth or in the incisal third will not affect the gingival health of the lower incisors.

Brandt's vole (Lasiopodomys brandtii) affects the dominant position of three gramineous species by altering defense traits and interspecific competition.

Rodents can cause considerable changes in plant community composition. However, relationships between shifts in species dominance and plant functional traits caused by rodents have seldom been investigated, especially for belowground functional traits. In this study, a set of enclosures was constructed to analyze the effects of 10 years of Brandt's voles' activities on the defense strategies and dominant position changes of three gramineous plants (Leymus chinensis, Stipa krylovii, and Cleistogenes squarrosa) in Inner Mongolia. Here, we measured the dominance, biomass, and fourteen functional traits of three plants. The effects of Brandt's voles on dominance, biomass, and functional traits were analyzed, and then we explored the effect of functional traits on plant dominance by using the structural equation model. Results showed that long-term feeding by Brandt's voles resulted in a significant decrease in the dominance of L. chinensis and S. krylovii, whereas C. squarrosa was positively affected. The belowground biomass of L. chinensis and S. krylovii was higher in the vole treatment, which showed that they were increasing their escape characteristics. The leaf thickness of L. chinensis and the leaf C:N ratio of S. krylovii significantly increased, while the specific leaf area of C. squarrosa significantly decreased. All three gramineous showed increased resistance traits in response to Brandt's voles, which positively affected their dominance. Tolerance-related traits of S. krylovii significantly increased, with the increasing growth rate of root length contributing to enhancing its dominance. We highlight that selective feeding by rodents led to the selection of different defense strategies by three gramineous plants, and that changes in biomass allocation and functional traits in the different species affected plant dominance, driving changes in the plant communities.

The impact of different recovery positions on the perfusion of the lower forearm and comfort: A cross-over randomized controlled trial.

Background: International guidelines recommend a side-lying recovery position for unresponsive individuals with normal breathing who do not require cardiopulmonary resuscitation. However, high-certainty evidence about an optimal recovery position is lacking. Recent guidelines recommend a position with the arm extended rather than bent, hypothesizing that venous drainage in the dependent lower arm might be compromised. This cross-over randomized controlled trial aims to evaluate the effect of recovery positions with bent or extended arm on perfusion of the lower forearm and comfort. Methods: Eight healthy volunteers were placed in each of the recovery positions for 15 min, in random order, with an interval of 15 min in supine position. Various perfusion indices of the dependent arm were assessed by radial artery tonometry, ulnar artery echo doppler, and venous congestion plethysmography, as well as participant discomfort, pain and skin discoloration. Differences in outcomes were analyzed with linear mixed models. Results: Our study found no statistically significant difference in systolic peripheral arterial pressure in the radial artery, peripheral venous pressure at the back of the hand, oxygen saturation, heart rate, subjective pain and discomfort, when comparing both postures. Participants slightly experienced more skin discoloration in the position with extended arm. Conclusions: We conclude that, since perfusion of the dependent arm was shown to be similar in both positions, both recovery positions can be used. These conclusions fill a gap in evidence and can further support the treatment recommendations regarding the recovery position in first aid settings.

A new method to orient a 3-dimensional facial model to natural head position: a preliminary report on accuracy and reproducibility.

OBJECTIVES: To establish and validate a novel method to orient a 3-dimensional (3D) facial model to natural head position (NHP) in a stereophotogrammetric system using a 2-dimensional frontal full-face photograph of NHP. MATERIAL AND METHODS: Specific technique procedure was reported for our method, and in vitro model experiment was performed for accuracy test. A preliminary volunteer study was then planned for reproducibility test. RESULTS: The accuracy on a 3D-printed test model was within 0.15°. Within an observational cohort of 22 dental students, the angular deviations of different maxillofacial regions (e.g., central forehead, left and right zygomatic regions, apex of nose and mental region) were no more than 2° between the 3D NHP models acquired with a shorter time-interval (1 hour from baseline) or a longer time-interval (7 days from baseline), which were all considered clinically insignificant. In addition, the angular deviations were significantly larger with a 7d-interval than with a 1h-interval, indicting a decline in 3D NHP reproducibility over short time duration. CONCLUSION: The current method may represent a clinically useful protocol for recording and transferring 3D NHP in stereophotogrammetry. CLINICAL RELEVANCE: It may provide reliable and meaningful reference information for evaluating craniofacial morphology, and be of clinical use in the diagnosis, treatment and follow-ups of patients with aesthetic or deformed craniofacial problems.

Story recall performance and AT classification via positron emission tomography: A comparison of logical memory and Craft Story 21.

BACKGROUND: Early detection of Alzheimer's disease (AD) is one of the critical components of the global response to the growing dementia crisis. Analysis of serial position performance in story recall tests has yielded sensitive metrics for the prediction of AD at low cost. In this study, we examined whether serial position markers in two story recall tests (the logical memory test, LMT, and the Craft Story 21 test, CST) were sensitive to cross-sectional biomarker-based assessment of in vivo neuropathology. METHODS: Participants were selected from the Wisconsin Registry of Alzheimer's Prevention (n = 288; WRAP) and the Alzheimer's Disease Research Center (n = 156; ADRC), both from the University of Wisconsin-Madison. Average age at PET was 68.9 (6.7) and 67.0 (8.0), respectively. Data included tau and PiB PET, and LMT for WRAP participants and CST for ADRC participants. Two sets of Bayesian analyses (logistic regressions and ANCOVAs) were conducted within each cohort, separately. RESULTS: Results indicated that the A+T+ classification was best predicted, cross-sectionally, by the recency ratio (Rr), indexing how much of the end of the story was forgotten between initial learning and delayed assessment. Rr outperformed traditional scores and discriminated between A+T+ and A+T-/A-T-, in both cohorts. CONCLUSIONS: Overall, this study confirms that serial position analysis of LMT and CST data, and particularly Rr as an index of recency loss, is a valuable tool for the identification of in vivo tau pathology in individuals free of dementia. Diagnostic considerations are discussed.

Bi-directional context-aware network for the nested named entity recognition.

The Span-based model can effectively capture the complex entity structure in the text, thus becoming the mainstream model for nested named entity recognition (Nested NER) tasks. However, traditional Span-based models decode each entity span independently. They do not consider the semantic connections between spans or the entities' positional information, which limits their performance. To address these issues, we propose a Bi-Directional Context-Aware Network (Bi-DCAN) for the Nested NER. Specifically, we first design a new span-level semantic relation model. Then, the Bi-DCAN is implemented to capture this semantic relationship. Furthermore, we incorporate Rotary Position Embedding into the bi-affine mechanism to capture the relative positional information between the head and tail tokens, enabling the model to more accurately determine the position of each entity. Experimental results show that compared to the latest model Diffusion-NER, our model reduces 20M parameters and increases the F1 scores by 0.24 and 0.09 on the ACE2005 and GENIA datasets respectively, which proves that our model has an excellent ability to recognise nested entities.

Detection and Evaluation for High-Quality CPR Based on Motion Capture Devices: A Preliminary Test.

High-quality cardiopulmonary resuscitation (CPR) is important for successful revival. This test aimed to accurately and effectively assess parameters in CPR operations, particularly focusing on the non-quantified arm posture, to assist instructors in guiding students to enhance the quality of their performance. We used motion capture system (Mars series, Nokov, China) to collect compression data from four trained students about five rounds of CPR, recording dynamic data of each marker in three-dimensional space following time. Using the processed data, we calculated compression depth, frequency, and arm angles. Their performance still needed improvement, and there were variations in data within individuals. This suggests that when instructors conduct assessments, they should focus on not only the overall performance but also each compression. This experiment provides a new perspective for quantifying compression parameters, and future efforts should continue to optimize and incorporate new parameters for assessment.

Position and root resorption of the incisors following anterior segment retraction using friction versus frictionless mechanics: A randomised controlled trial.

AIM: To evaluate the three-dimensional position and root resorption of incisors after anterior segment retraction (ASR) using friction versus frictionless mechanics. PARTICIPANTS AND METHODS: Thirty female patients (13-18 years) with bimaxillary protrusion were randomly allocated into two groups. In the intervention group, ASR was undertaken using an elastomeric chain rendering 160 g/side extending between mini-screw implant and a hook crimped on 0.017 × 0.025-inch stainless-steel wire distal to the lateral incisor. In the comparison group, ASR was undertaken using closing T-loops fabricated from 0.017 × 0.025-inch titanium molybdenum alloy (TMA) wire rendering comparable retraction force. In both groups, the canine brackets were ligated after retraction to the mini-screw implants that were inserted in both the upper and lower arches bilaterally. The primary outcome was the three-dimensional changes in the position of the incisors. The secondary outcome was root resorption. These were measured from cone-beam computed tomography scans. RESULTS: Statistically significant decreases in the upper (UI) and lower incisors (LI) crown torque were seen in both groups; however, the difference between groups was not statistically or clinically significant (UI MD -2.04°; 95% confidence interval [CI] = -8.02-3.95; LI MD -0.49°; 95% CI = -7.06-6.08). Significant tipping of upper (MD -1.17°; 95% CI = -2.06--0.27) and lower (MD -1.13°; 95% CI = -1.66--0.60) incisors was found in the friction, but not the frictionless group after retraction; however, the changes were not clinically significant. Significant lower incisor intrusion was found in both groups after retraction; however, the difference between groups was not statistically or clinically significant (MD -0.61°; 95% CI = -1.99-0.77). Statistically significant decreases in the UI and LI root length were seen in both groups. The difference between groups for UI changes was statistically significant (MD 0.54 mm; 95% CI = -0.02-1.07) but probably not clinically significant. CONCLUSION: Considering the limitations in the current study, there was no advantage of either mechanics over the other regarding the final position of incisors. The likelihood of root resorption should be considered when frictionless mechanics are used for retraction of incisors. REGISTRY: Clinicaltrials.gov (NCT04878939).

Understanding the Physiological Connection: Cardiac Arrest Following Prone Positioning.

Prone positioning of patients is a routine occurrence in procedural suites and operating rooms (ORs). However, the physiological changes that occur with prone positioning are frequently underappreciated by proceduralists, surgeons, and anesthesiologists. This may be related to a sense of the routine or a lack of familiarity with physiological changes that accompany the prone position. The prone position, while aiding visualization and cannulation of the ampulla of Vater during endoscopic retrograde cholangiopancreatography (ERCP), can induce physiological changes such as reduced preload, inferior vena cava filling, and cardiac output; it can also increase intrathoracic pressure and mediastinal compression. Anesthetic agents can further impact cardiopulmonary physiology, decreasing systemic vascular resistance and reducing cardiac contractility. In addition, the transition from negative to positive pressure ventilation following endotracheal intubation can increase pulmonary artery pressures and right ventricular (RV) strain. Therefore, caution is needed with patients who have RV dysfunction, pulmonary hypertension, or preload dependency, as they may not tolerate prone positioning. We describe a case in which a 73-year-old male patient scheduled for an ERCP suffered cardiac arrest after being transitioned to the prone position. The patient was repositioned in the supine position and resuscitated. The case was completed in the supine position.

Socioeconomic inequalities in intakes of ultra-processed and minimally processed foods in nationally representative samples of adults in Canada: An analysis of trends between 2004 and 2015.

BACKGROUND: Individuals with a lower socioeconomic position (SEP) often have higher intakes of ultra-processed (UPF) and lower intakes of minimally processed foods (MPF); however, studies have not examined trends in absolute and relative gaps and gradients in UPF and MPF intake using multiple indicators of SEP. OBJECTIVE: We examined within-year absolute and relative gaps and gradients in UPF and MPF intake and trends between 2004 and 2015 according to six indicators of SEP among nationally representative samples of adults in Canada. METHODS: Adults (≥18 years) in the Canadian Community Health Survey-Nutrition 2004 (n=20,880) or 2015 (n=13,970) reported SEP (individual and household education, household income adequacy, household food insecurity, neighborhood material and social deprivation) and completed a 24-hour dietary recall. Multivariable linear regression assessed within-year absolute and relative gaps and gradients in the proportion of energy from UPF and MPF and trends between 2004 and 2015. RESULTS: The largest and most consistent within-year inequities in UPF and MPF intake were for individual and household educational attainment. Overall and among males, higher SEP groups had more favorable intakes over time based on trends in absolute and relative gaps and gradients in UPF and MPF intake by household food insecurity (e.g., the absolute gap in UPF intake declined from -1.2% [95%CI: -5.3%, 2.9%] to -7.9% of energy [95%CI: -11.2%, -4.5%] in the overall population). Overall and among males, lower SEP groups had more favorable intakes over time based on trends in absolute and relative gaps in UPF and MPF intake by neighborhood material deprivation. CONCLUSIONS: Socioeconomic inequalities in UPF and MPF intake were most pronounced for individual and household education. Between 2004 and 2015, several inequalities in UPF and MPF intake emerged according to household food insecurity (favoring higher SEP groups) and neighborhood material deprivation (favoring lower SEP groups).

Cerebral hemodynamic response to upright position in acute ischemic stroke.

Introduction: Concerns exist that a potential mechanism for harm from upright activity (sitting, standing, and walking) early after an acute ischaemic stroke could be the reduction of cerebral perfusion during this critical phase. We aimed to estimate the effects of upright positions (sitting and standing) on cerebral hemodynamics within 48 h and later, 3-7 days post-stroke, in patients with strokes with and without occlusive disease and in controls. Methods: We investigated MCAv using transcranial Doppler in 0° head position, then at 30°, 70°, 90° sitting, and 90° standing, at <48 h post-stroke, and later at 3-7 days post-stroke. Mixed-effect linear regression modeling was used to estimate differences in MCAv between the 0° and other positions and to compare MCAv changes across groups. Results: A total of 42 stroke participants (anterior and posterior circulation) (13 with occlusive disease, 29 without) and 22 controls were recruited. Affected hemisphere MCAv decreased in strokes with occlusive disease (<48 h post-stroke): from 0° to 90° sitting (-9.9 cm/s, 95% CI[-16.4, -3.4]) and from 0° to 90° standing (-7.1 cm/s, 95%CI[-14.3, -0.01]). Affected hemisphere MCAv also decreased in strokes without occlusive disease: from 0° to 90° sitting (-3.3 cm/s, 95%CI[-5.6, -1.1]) and from 0° to 90° standing (-3.6 cm/s, 95%CI [-5.9, -1.3]) (p-value interaction stroke with vs. without occlusive disease = 0.07). A decrease in MCAv when upright was also observed in controls: from 0° to 90° sitting (-3.8 cm/s, 95%CI[-6.0, -1.63]) and from 0° to 90° standing (-3 cm/s, 95%CI[-5.2, -0.81]) (p-value interaction stroke vs. controls = 0.85). Subgroup analysis of anterior circulation stroke showed similar patterns of change in MCAv in the affected hemisphere, with a significant interaction between those with occlusive disease (n = 11) and those without (n = 26) (p = 0.02). Changes in MCAv from 0° to upright at <48 h post-stroke were similar to 3-7 days. No association between changes in MCAv at <48 h and the 30-day modified Rankin Scale was found. Discussion: Moving to more upright positions <2 days post-stroke does reduce MCAv in the affected hemisphere; however, these changes were not significantly different for stroke participants (anterior and posterior circulation) with and without occlusive disease, nor for controls. The decrease in MCAv in anterior circulation stroke with occlusive disease significantly differed from without occlusive disease. However, the sample size was small, and more research is warranted to confirm these findings.

Factors that influence the angular error in active knee angle reproduction tests: A systematic review and meta-analysis.

Purpose: The systematic review and meta-analysis investigated subject-independent test factors that influence the absolute angle error in active knee angle reproduction tests. Methods: Five electronic databases were searched to identify relevant studies published before 20 December 2023. Studies were included that were published in either English or German and that investigated joint proprioception in the healthy knee. Included studies were also required to have participants 18-60 years old and free of lower-limb injury, neurological disorders and diseases affecting joint position sense. Risk of bias was assessed using a Cochrane risk-of-bias tool. Results: Of the 2023 articles identified, 26 studies (1082 participants) were included in the meta-analysis. The meta-analysis showed a significant pooled standard mean difference in the absolute angular error for body orientation, direction of movement and fatigue. Active knee angle reproduction tests were found to have a lower absolute angular error when performed in the sitting position compared to the prone position (SMD = -0.56; 95% CI = -1.00 to -0.12). The absolute angular error was found to be greater in cases of knee flexion compared to knee extension (SMD = 0.71; 95% CI = 0.18-1.24). General and local muscle fatigue were found to result in a higher absolute angular error (SMD = 1.39; 95% CI = 1.04-1.75). Conclusion: Hence, fatigue, body orientation and direction of movement influence the extent of the absolute angular error in active knee angle reproduction tests. Practitioners should be aware that the test conditions and the patient's level of fatigue can affect the results of such tests and that directly comparing results obtained using different test protocols may not be appropriate. The test protocol should be well documented and applied consistently in the clinical setting. Level of Evidence: Level III, systematic review with meta-analysis.

Frailty and socioeconomic position: A systematic review of observational studies.

BACKGROUND: Frailty, an age-related state of reduced physiological reserve, is often associated with lower socio-economic position (SEP). This systematic review synthesised observational studies assessing (i) the association between SEP and frailty prevalence; (ii) how changes in frailty status over time vary by SEP; and (iii) whether the association between frailty and clinical outcomes is modified by SEP. METHODS: We searched three electronic databases from 2001 to 2023. We included observational studies measuring early-, mid-, and late-life indicators of SEP (education, income, wealth, housing, occupation, and area-based measures of multiple deprivation) and frailty (assessed using any validated measure). Screening and extraction were performed in duplicate. Findings were synthesised using narrative synthesis. RESULTS: We included 383 studies reporting findings from 265 independent samples/cohorts across 64 countries. Lower SEP was associated with higher frailty prevalence across all indicators (childhood deprivation 7/8 studies, education 227/248, occupation 28/32, housing 8/9, income 98/108, wealth 39/44 and area-based deprivation 32/34). Lower SEP was also associated with higher frailty incidence (27/30), with greater odds of transitioning towards a more severe frailty state (35/43), lower odds of frailty reversion (7/11), and (in some studies) with more rapid accumulation of deficits (7/15). The relationship between frailty and mortality was not modified by SEP. INTERPRETATION: Preventative measures across multiple levels of individual and structural inequality are likely to be required to reduce the rising levels of frailty. Resourcing of interventions and services to support people living with frailty should be proportionate to needs in the population to avoid widening existing health inequalities.

Evaluation of the effect of trendelenburg position duration on intracranial pressure in laparoscopic hysterectomies using ultrasonographic optic nerve sheath diameter measurements.

BACKGROUND: During laparoscopic surgery, pneumoperitoneum and Trendelenburg positioning applied to provide better surgical vision can cause many physiological changes as well as an increase in intracranial pressure. However, it has been reported that cerebral autoregulation prevents cerebral edema by regulating this pressure increase. This study aimed to investigate whether the duration of the Trendelenburg position had an effect on the increase in intracranial pressure using ultrasonographic optic nerve sheath diameter (ONSD) measurements. METHODS: The near infrared spectrometry monitoring of patients undergoing laparoscopic hysterectomy was performed while awake (T0); at the fifth minute after intubation (T1); at the 30th minute (T2), 60th minute (T3), 75th minute (T4), and 90th minute (T5) after placement in the Trendelenburg position; and at the fifth minute after placement in the neutral position (T6). RESULTS: The study included 25 patients. The measured ONSD values were as follows: T0 right/left, 4.18±0.32/4.18±0.33; T1, 4.75±0.26/4.75±0.25; T2, 5.08±0.19/5.08±0.19; T3, 5.26±0.15/5.26±0.15; T4, 5.36±0.11/5.37±0.12; T5, 5.45±0.09/5.48±0.11; and T6, 4.9±0.24/4.89±0.22 ( p < 0.05 compared with T0). ). No statistical difference was detected in all measurements in terms of MAP, HR and ETCO2 values compared to the T0 value (p > 0.05). CONCLUSIONS: It was determined that as the Trendelenburg position duration increased, the ONSD values ​​increased. This suggests that as the duration of Trendelenburg positioning and pneumoperitoneum increases, the sustainability of the mechanisms that balance the increase in intracranial pressure becomes insufficient. TRIAL REGISTRATION: This study was registered at Clinical Trials.gov on 21/09/2023 (registration number NCT06048900).

Kinematics characteristics of key point of interest during tennis serve among tennis players: a systematic review and meta-analysis.

The objective of this systematic review and meta-analysis was to provide an overview of kinematic parameters associated with key points of interest in the tennis serve. The research was conducted according to the PRISMA guideline without date restriction. Google scholar, Science Direct, PubMed/Medline, Mendeley, and Science.gov databases were scanned to find relevant studies. Only English peer-review original article focused on joint body angles at trophy position, racket low point and ball impact were retained. The review, quality appraisal, and data extraction from selected studies were performed independently by two reviewers. A meta-analysis was carried out on the most studied joint parameters. Among the 2,844 records identified, 27 articles were included. The wide variety of methods used required data homogenization for comparison purposes. Trunk inclination (25.0 ± 7.1°) and front knee flexion (64.5 ± 9.7°) were the most studied parameters for trophy position. Shoulder lateral rotation (130.1 ± 26.5°) was systematically evaluated for racket low point. At ball impact, shoulder elevation (110.7 ± 16.9°) and elbow flexion (30.1 ± 15.9°) were the most considered joint angles. The systematic review revealed that many kinematic parameters were not quantified at the various key points of interest. Knowledge of the kinematics is essential for understanding the gesture, implementing training methods, and improving the performance.

Quantitative assessment of intertarget position variations based on 4D-CT and 4D-CBCT simulations in single-isocenter multitarget lung stereotactic body radiation therapy.

BACKGROUND: In single-isocenter multitarget stereotactic body radiotherapy (SBRT), geometric miss risks arise from uncertainties in intertarget position. However, its assessment is inadequate, and may be interfered by the reconstructed tumor position errors (RPEs) during simulated CT and cone beam CT (CBCT) acquisition. This study aimed to quantify intertarget position variations and assess factors influencing it. METHODS: We analyzed data from 14 patients with 100 tumor pairs treated with single-isocenter SBRT. Intertarget position variation was measured using 4D-CT simulation to assess the intertarget position variations (ΔD) during routine treatment process. Additionally, a homologous 4D-CBCT simulation provided RPE-free comparison to determine the impact of RPEs, and isolating purely tumor motion induced ΔD to evaluate potential contributing factors. RESULTS: The median ΔD was 4.3 mm (4D-CT) and 3.4 mm (4D-CBCT). Variations exceeding 5 mm and 10 mm were observed in 31.1% and 5.5% (4D-CT) and 20.4% and 3.4% (4D-CBCT) of fractions, respectively. RPEs necessitated an additional 1-2 mm safety margin. Intertarget distance and breathing amplitude variability showed weak correlations with variation (Rs = 0.33 and 0.31). The ΔD differed significantly by locations (upper vs. lower lobe and right vs. Left lung). Notably, left lung tumor pairs exhibited the highest risk. CONCLUSIONS: This study provide a reliable way to assess intertarget position variation by using both 4D-CT and 4D-CBCT simulation. Consequently, single-isocenter SBRT for multiple lung tumors carries high risk of geometric miss. Tumor motion and RPE constitute a substantial portion of intertarget position variation, requiring correspondent strategies to minimize the intertarget uncertainties.

Comparison of head posture and neck proprioceptive sense of individuals with chronic neck pain and healthy controls: A cross-sectional study.

BACKGROUND: Chronic pain can affect body perception at the central level by causing the somatosensory cortex to rearrange. Additionally, cervical afferent abnormalities in individuals with neck pain can impair proprioceptive sensitivity, potentially leading to alterations in body alignment and biomechanics. Nevertheless, there are insufficient studies exploring these notions. OBJECTIVE: The main objective of this study was to compare the head posture and neck proprioceptive sense of individuals with chronic neck pain and healthy controls. METHODS: Utilizing a cross-sectional study, a total of 76 volunteers comprising 38 individuals with neck pain and 38 matched healthy controls participated in the study. Head posture and cervical joint position sense were measured using a Cervical Range of Motion Deluxe (CROM) device. Firstly, the deviation angles of the head in three planes were evaluated, then the Head Repositioning Accuracy (HRA) test was performed to determine the joint position error. Visual Analogue Scale (VAS) was used to determine the severity of pain in individuals with neck pain. RESULTS: The deviation angles of the head in all three planes were significantly lower in the healthy control group (p< 0.05). Joint position error values were significantly higher in all directions (flexion-extension, right-left lateral flexion, and rotation) in the neck pain group (p< 0.001). CONCLUSION: The findings show that the proprioceptive sensation of the cervical region in individuals with neck pain was adversely affected, with changes were observed in the head posture. NOTE: The abstract of this study was presented as a verbal declaration at the International Congress of Health Sciences-ICHES-IDU 2020 that was held in Izmir on 20-21 June 2020.

Is social disadvantage a chronic stressor? Socioeconomic position and HPA axis activity among older adults living in England.

INTRODUCTION: Living in socioeconomic disadvantage has been conceptualised as a chronic stressor, although this contradicts evidence from studies using hair cortisol and cortisone as a measure of hypothalamus-pituitary-adrenal (HPA)1 axis activity. These studies used complete case analyses, ignoring the impact of missing data for inference, despite the high proportion of missing biomarker data. The methodological limitations of studies investigating the association between socioeconomic position (SEP)2 defined as education, wealth, and social class and hair cortisol and cortisone are considered in this study by comparing three common methods to deal with missing data: (1) Complete Case Analysis (CCA),3 (2) Inverse Probability Weighting (IPW) 4and (3) weighted Multiple Imputation (MI).5 This study examines if socioeconomic disadvantage is associated with higher levels of HPA axis activity as measured by hair cortisol and cortisone among older adults using three approaches for compensating for missing data. METHOD: Cortisol and cortisone levels in hair samples from 4573 participants in the 6th wave (2012-2013) of the English Longitudinal Study of Ageing (ELSA)6 were examined, in relation to education, wealth, and social class. We compared linear regression models with CCA, weighted and multiple imputed weighted linear regression models. RESULTS: Social groups with certain characteristics (i.e., ethnic minorities, in routine and manual occupations, physically inactive, with poorer health, and smokers) were less likely to have hair cortisol and hair cortisone data compared to the most advantaged groups. We found a consistent pattern of higher levels of hair cortisol and cortisone among the most socioeconomically disadvantaged groups compared to the most advantaged groups. Complete case approaches to missing data underestimated the levels of hair cortisol in education and social class and the levels of hair cortisone in education, wealth, and social class in the most disadvantaged groups. CONCLUSION: This study demonstrates that social disadvantage as measured by disadvantaged SEP is associated with increased HPA axis activity. The conceptualisation of social disadvantage as a chronic stressor may be valid and previous studies reporting no associations between SEP and hair cortisol may be biased due to their lack of consideration of missing data cases which showed the underrepresentation of disadvantaged social groups in the analyses. Future analyses using biosocial data may need to consider and adjust for missing data.