Cranial remolding orthosis for children with deformational skull deformities: A systematic review on the factors affecting success and duration of treatment.

Deformational plagiocephaly, deformational brachycephaly, and deformational scaphocephaly are the most common types of skull deformities during the first year of life. Using a cranial remolding orthosis (CRO) can have an important role in achieving a satisfactory level of improvement in symmetry and proportion of the deformed skulls. However, there is no consensus on the most important parameters for the success or length of treatment with a CRO. In this study, we did a systematic literature review in PubMed, Scopus, Web of Science, and EMBASE on January 2023. Titles/abstracts of the found studies were screened by two independent reviewers. The Newcastle-Ottawa Scale was used to evaluate the quality of the included articles. The best evidence synthesis was considered to determine the strength of the reported factors. A total of 25 articles with an accumulated sample of 7594 participants were included. Nine predictive factors, including age at initiation of CRO treatment, CRO compliance, deformity severity, deformity type, torticollis, gestational age, gestational type, delivery method, and developmental delay, were considered for CRO treatment length or success. Moderate evidence suggests that CRO treatment length is linked to a patient's age at the start of treatment and the deformity severity. Moreover, treatment success is correlated with a patient's age at the start of treatment, CRO compliance, and deformity severity. Moderate evidence indicates that there is no relationship between the presence of torticollis and gestational age with CRO treatment success.

Online education for prosthetics and orthotics students in the era of COVID-19 pandemic in Iran: challenges, opportunities, and recommendations.

INTRODUCTION: With the advent of the COVID-19 pandemic, many higher education programs in Iran, including prosthetics and orthotics (P&O), had to shift to the online environment all at once. This unanticipated transition was challenging for the educational system. However, online education is superior in some aspects to conventional methods, and this situation may offer opportunities. This study was carried out from September 2021 to March 2022 to investigate the challenges and opportunities of online education in the P&O sector in Iran based on the opinions of students and faculty members. Relevant recommendations will also be discussed. METHODS: In this qualitative study, semi-structured interviews were conducted in both oral and written formats. Purposive and snowball sampling techniques were used to recruit undergraduate and postgraduate P&O students, as well as P&O faculty members, for this qualitative study. The data gathered from interviews with study participants were analyzed by thematic analysis. RESULTS: Based on the data analysis, many sub-themes of the three main themes were recognized: (1) challenges: technical, socioeconomic, environmental distractors, supervision and evaluation, workload, digital competence, interactions, motivation, sessions-related issues, class time, hands-on and clinical training; (2) opportunities: technological innovations, infrastructure development, flexible learning environment, student-centered learning, availability of contents, time and cost saving, high concentration, more self-confidence; (3) recommendations: technical infrastructure, team dynamics, hybrid courses, time management, awareness. CONCLUSION: Online education of P&O during the era of the COVID-19 pandemic was accompanied by a series of challenges. Technical issues and the gravity of hands-on training in this field were significant challenges. This era, however, provided the opportunity to facilitate the establishment of needed infrastructure and support technological innovations for online education. Considering hybrid (mixed online and on-site) courses was recommended to improve the quality of learning.

Does Bracing Control the Progression of Adolescent Idiopathic Scoliosis in Curves Higher Than 40°? A Systematic Review and Meta-analysis.

Routinely, adolescent idiopathic scoliosis (AIS) curves that progress beyond 40° in skeletally immature adolescents require surgery. However, some adolescents with AIS and their parents utterly refuse surgery and insist on wearing a brace. Debate continues regarding the appropriateness of bracing for AIS curves exceeding 40° in patients who have rejected surgical intervention. This systematic review and meta-analysis was conducted to review the literature on the effectiveness of bracing and its predictive factors in largermagnitude AIS curves ≥40°. This study replicated the search strategy used by the PICOS system for formulating study questions, which include consideration of the patient/population (P), intervention (I), comparison (C), outcome (O), and study design (S). The search was conducted up to January 2022 in the following bibliographic online databases only in the English language: PubMed, Google Scholar, Scopus, and Web of Science. Two assessors reviewed the articles for qualification. Eligible studies were assessed for risk of bias at the study level using the Newcastle-Ottawa Scale. The effect size across the studies was determined using standardized mean differences (Cohen's d) and 95% confidence intervals for the meta-analysis. Among the eight included moderate quality studies, evidence of potential publication bias (p <0.05) for the trials included was found in the Cobb angle outcome. Results obtained through meta-analysis indicated that the effectiveness of bracing in controlling Cobb angle progression in curves ≥40° is significantly positive. Additionally, initial curve severity, Risser stage, in-brace curve correction, curve type, and apical vertebral rotation were considered risk factors associated with brace effectiveness. This systematic review revealed that bracing could alter the normal course of AIS curves ≥40° in patients refusing posterior spinal fusion (PSF). However, the suggested course for patients refusing PSF remains unclear because of the significant heterogeneity in the risk factors associated with bracing failure.

Brace-Related Stress and Quality-of-Life Parameters in Adolescents with Idiopathic Scoliosis.

Introduction: This study investigated brace-related stress, trunk appearance perception, and quality of life in adolescent girls with idiopathic scoliosis who wear the Milwaukee brace for treatment. Methods: Fifty-two adolescent girls with idiopathic scoliosis participated in this study. They had been under treatment with Milwaukee brace for at least three months. They filled out four questionnaires, including the revised 22-item Scoliosis Research Society questionnaire (SRS-22r), the Brace Questionnaire (BrQ), the Bad Sobernheim Stress Questionnaire-Brace (BSSQ-Brace), and the Trunk Appearance Perception Scale (TAPS). Results: Twenty participants had high stress levels, and thirty-two had moderate stress levels. The total score and emotional and social function scores of the BrQ were significantly higher in participants with high stress compared to those with moderate stress. There was no significant difference between the two groups in the SRS-22r and TAPS questionnaires scores. However, a high Cobb angle had significantly worsened their perception of trunk appearance. Conclusions: It seems that among quality-of-life parameters, social and emotional functions are more affected by stress level in treating adolescent girls with idiopathic scoliosis with a brace. In addition, patients with high stress levels have a worse perception of their trunk appearance.

Single subject analysis of individual responses to prosthetic modifications based on passive dynamic walking model.

BACKGROUND: Group statistical analysis may mask individual differences in response to interaction with rehabilitative devices such as prostheses. This study sets out to evaluate the effect of asymmetric prosthesis using a single subject methodology on individuals with unilateral transfemoral amputation. METHODS: Acceleration data of 17 participants with unilateral transfemoral amputation were collected using a triaxial accelerometer attached at the L3 level of the spine during level ground walking under four prosthesis conditions: 1) no added mass; 2) the knee joint relocated downwards by 18% of the total shank length, shank mass decreased by 68%, thigh mass increased by 7%; 3) the knee joint relocated downwards by 37% of the total shank length, shank mass decreased by 68%, thigh mass increased by 7%, and 4) thigh mass increased 17%, shank mass decreased by 38%. Step length, step time, step length variability, step time variability and Floquet multiplier were statistically assessed. FINDINGS: The single subject analysis highlighted that under prosthetic modifications, intact limb step length was increased and prosthetic step length was deceased in most participants (n > 9). No significant changes were observed in Floquet multiplier (n > 14), step length (n > 6) and step time variability (n > 9) across all conditions. INTERPRETATION: Single subject analysis showed that in response to the immediate effect of asymmetric prosthesis, increase in the intact limb step length and decrease in the prosthetic limb step length emerged as a dominant strategy for most participants. Regarding Floquet multiplier, step length, and step time variability, our prosthetic modifications did not produce the anticipated effects.

Disease-Specific Outcome Measures Evaluating the Health-Related Quality of Life of Children and Adolescents with Idiopathic Scoliosis and Scheuermann's Kyphosis: A Literature Review.

Adolescent idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) are the most common types of spinal deformities in adolescents, and both have substantial ramifications on health-related quality of life (HRQoL) parameters. Various questionnaires have been developed to assess HRQoL in age-group populations with spinal deformity. Nevertheless, there remains a lack of consensus across the literature as to which instrument is the most suitable for evaluating the HRQoL of this cohort. Thus, this literature review was conducted to present disease-specific questionnaires for children and adolescents with AIS and SK to provide their psychometric characteristics (validity, reliability, and responsiveness) across different languages. A literature search was performed in the Medline (PubMed), Scopus, EMBASE, and Google Scholar databases. Studies that outlined the development and application of questionnaires evaluating HRQoL of children and adolescents with spinal deformity were included, and data on their validity and reliability in different translated languages were collected. A total of 10 disease-specific questionnaires were identified. Except for one questionnaire that was a proxy-reported measure, the other questionnaires were self-reported. We determined that selecting the proper questionnaire for clinical and research purposes requires careful consideration of various factors including the type of treatment intervention planned as well as various patient demographic factors. For children with early-onset scoliosis, the ideal questionnaire to evaluate their HRQoL is the Early-Onset Scoliosis Questionnaire-24. For adolescents with AIS and SK who are potential candidates for surgical intervention, the use of Scoliosis Research Society-22, Scoliosis Japanese-27, and Quality of Life Profile Spinal Deformity questionnaires is appropriate. For patients who are under nonsurgical treatment, the Brace Questionnaire and Italian Spine Youth Quality of Life questionnaires can be utilized. Nonetheless, when the specific intent of a study is to evaluate the self-image perception of patients, the use of drawing-based questionnaires may be the optimal choice.

The Italian Spine Youth Quality of Life questionnaire: reliability and validity of the Persian version in adolescents with spinal deformities.

PURPOSE: To assess the reliability and validity of the Persian version of the Italian Spine Youth Quality of Life (P-ISYQOL) questionnaire. METHODS: Forward/backward translations and cultural adaption processes of the ISYQOL questionnaire into Persian were conducted by an expert committee. We recruited 178 adolescents with idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) and 103 age-matched adolescents with no spinal deformity. Reliability was assessed by evaluating internal consistency and test-retest reliability using Cronbach's alpha and intraclass correlation coefficient (ICC). Convergent construct validity was assessed by measuring the association between the ISYQOL and revised 22-item Scoliosis Research Society (SRS-22r) questionnaires scores. Known-groups construct validity was assessed regarding curve magnitude, deformity, age, sex, and treatment type. RESULTS: Cronbach's alpha and ICC for P-ISYQOL total score was 0.8 and 0.9, respectively. An acceptable association was observed between P-ISYQOL and SRS-22r total scores (r = - 0.5, p < 0.01). The P-ISYQOL could discriminate between adolescents with spinal deformities and adolescents with no spinal deformity as well as those with different types of deformity and treatment (p < 0.01). CONCLUSIONS: The P-ISYQOL is a reliable and valid survey to assess the outcomes of adolescents with spinal deformities. LEVEL OF EVIDENCE: Level I-diagnostic studies.

Predictive Factors for Outcomes of Overcorrection Nighttime Bracing in Adolescent Idiopathic Scoliosis: A Systematic Review.

Predictive clinical and radiological factors can potentially identify adolescent idiopathic scoliosis (AIS) most likely to benefit from overcorrection nighttime bracing. These factors can provide helpful information in clinical decision making. However, the relationship between these factors and outcomes of overcorrection nighttime bracing is unclear. This systematic review determined the predictive factors for identifying outcomes of overcorrection nighttime bracing in AIS. A systematic search was conducted on PubMed, MEDLINE, Scopus, and Embase from January 1986 to January 2021. Studies on AIS patients, aged 10-18 years, with a Risser sign of 0-2 and an initial Cobb angle of 20°-45°, who were treated with overcorrection nighttime bracing and for whom at least one predictive factor of treatment outcome (failure and/or success) was assessed were included. Two blinded reviewers independently evaluated the studies using a quality assessment tool. To determine predictive factors, the level of evidence was rated through best-evidence synthesis. A total of nine studies met the inclusion criteria. A Providence brace was used in six of the included studies, while a Charleston bending brace was used in three. Findings from two high-quality studies provided strong evidence of the association between curve flexibility and brace treatment success. In terms of the Risser sign, this evidence was obtained from three high-quality studies. Moderate evidence indicated a positive association between premenarchal status and nighttime bracing failure. Inconclusive evidence indicated that poor brace compliance is associated with treatment failure. Conflicting evidence of treatment failure was indicated for initial curve magnitude, curve type, in-brace correction, age, Risser sign, curve apex, and sex. These findings show that greater curve flexibility and a higher Risser sign are associated with overcorrection nighttime bracing success.

Assessment of reliability and validity of the adapted Persian version of the Spinal Appearance Questionnaire in adolescents with idiopathic scoliosis.

PURPOSE: This study investigates the reliability and validity of the adapted Persian version of the Spinal Appearance Questionnaire (P-SAQ). METHODS: The stages of cross-cultural adaptation were conducted according to an internationally accepted guidelines. Reliability of the P-SAQ was measured by evaluating internal consistency and test-retest reproducibility using Cronbach's α and intraclass correlation coefficient (ICC). Validity of the P-SAQ was assessed by factor analysis, and convergent and known-groups validities. Convergent validity was assessed through participant response on the P-SAQ and the revised 22-item Persian version of the Scoliosis Research Society (SRS-22r) questionnaire. Known-groups validity was assessed by comparing the P-SAQ scores according to the patients curve magnitude and treatment type. RESULTS: A total of 106 patients with a diagnosis of adolescent idiopathic scoliosis (AIS) were included. The P-SAQ demonstrated an acceptable internal consistency with a Cronbach's α of 0.77 (range 0.65-0.72). The test-retest reliability was excellent (range ICC 0.85-0.98). There was a correlation between the total score, average scores of the general, curve, rib prominence, kyphosis, and trunk shift subscales of the P-SAQ and subtotal and total scores of the SRS-22r, r = - 0.2 to - 0.4, p < 0.05. The P-SAQ discriminated between patients with differing Cobb angle magnitudes and treatment types (p < 0.01). Factor analysis supported the use of the appearance and expectations items as separate scales for the P-SAQ. CONCLUSION: The P-SAQ is a valid and reliable tool that could be utilized to evaluate the perception of appearance for Persian-speaking AIS patients with different curve magnitude and treatment strategies. LEVEL OF EVIDENCE: Level I- diagnostic studies.

Simultaneous Analysis of 10 Priority PAHs in Iranian Sangak Bread Samples by Developing a GC-MS Method.

Human exposure to polycyclic aromatic hydrocarbons (PAHs) is known as a carcinogen risk factor. In this study, a gas chromatography-mass spectrometry (GC-MS) technique combined with the QuEChERS extraction method was developed for concurrent analysis of 10 polycyclic aromatic hydrocarbons (PAHs) in Iranian traditional Sangak bread samples. The method was validated by determining different parameters, including; linearity, accuracy, precision, limit of detection (LOD) and limit of quantitation (LOQ). Calibration curves showed a linear relationship in the concentration range of 10-500 ng/g with a coefficient of determination (R2) ranged between 0.994 and 0.999. The obtained mean recoveries were 92-106% with the relative standard deviations (RSDs) in the range of 3-7% with an acceptable precision (RSD < 20%). The Limit of detections (LODs) for different PAHs were between 0.14-0.78 ng/g, while the limit of quantitation (LOQ) was 0.46-2.60 ng/g. Matrix effect studies showed that the analytes concluded signal suppressions or enhancements. Therefore, spiked calibration curves were used for overcoming this issue. The result of Sangak bread samples analysis using the validated method showed that 9 (19.4%) out of 47 Sangak bread samples were contaminated with phenanthrene (PHE) and anthracene (ANT) at the mean level of 10.08 ± 6.38 ng/g which were higher than the permissible limit of European Commission regulatory control value for BaP (1 µg/kg of wet weight) in processed cereal-based foods and baby foods for infants and young children.

Telework and telerehabilitation programs for workers with a stroke during the COVID-19 pandemic: A commentary.

BACKGROUND: Due to the coronavirus disease 2019 (COVID-19) pandemic, rehabilitation facilities have become less accessible for patients with a stroke. Lack of early, intensive rehabilitation misses the opportunity for recovery during the critical time window of endogenous plasticity and improvement post-stroke. OBJECTIVES: The purpose of this commentary was to highlighting the benefits of telework and telerehabilitation programs for workers with a stroke during the COVID-19 pandemic. METHODS: Relevant publications regarding the management of individuals with a stroke, telerehabilitation and teleworking in the setting of COVID-19 were reviewed. RESULTS: Previous studies showed that telerehabilitation can effectively provide an alternate method of promoting recovery for patients with a stroke. With the physical distancing precautions in place for mitigating viral spread, teleworking can also provide a method for long term recovery and improvements in quality of life after a stroke. CONCLUSIONS: Overall, this commentary addresses the benefits of physically distant, safe and effective alternatives to support individuals who live with a stroke during COVID-19 pandemic.

The comprehensive lower limb amputee socket survey: Reliability and validity of the persian version.

BACKGROUND: The Comprehensive Lower limb Amputee Socket Survey (CLASS) is a self-reported measure developed to assess prosthetic socket fit in individuals with lower limb amputation. OBJECTIVE: To assess the reliability and validity of the Persian version of the CLASS. STUDY DESIGN: Cross-sectional and repeated-measures. METHODS: We evaluated the translation and back translation of the CLASS and made the required changes according to expert committee feedback. Then, we recruited 124 participants with unilateral lower limb amputation (89.5% men). Internal consistency was analyzed with Cronbach's alpha and test-retest reliability using intra-class correlation coefficients. Convergent construct validity was assessed by comparing the CLASS scores with the Persian version of the Trinity Amputation and Prosthesis Experience Scales (TAPES) scores. In addition, known groups construct validity was assessed by comparing CLASS scores between groups with different causes and levels of amputation. RESULTS: Cronbach's alpha coefficient represented a very good internal consistency for all domains of the Persian CLASS (ranged from 0.86 to 0.92). The intra-class correlation coefficient for test-retest reliability for the Persian CLASS was good to excellent (ranged from 0.73 to 0.97). There was a significant correlation between the subscales of the Persian CLASS and satisfaction subscales of the Persian TAPES (p < 0.001). There was significant difference between comfort subscale of the Persian CLASS scores by level of amputation. CONCLUSION: The Persian CLASS is a reliable and valid measure for evaluating prosthetic socket fit.

Effect of cycling and functional electrical stimulation with linear and interval patterns of timing on gait parameters in patients after stroke: a randomized clinical trial.

OBJECTIVE: Patients in the chronic phase after a stroke are an underrepresented group in the literature. Therefore, the aim of this study was to compare the effects of cycling and functional electrical stimulation with linear versus interval patterns of timing on gait parameters in patients after stroke. DESIGN: A double blinded, parallel, randomized clinical trial. SETTING: Neuroscience Institute. PARTICIPANTS: Patients with lower limb disability due to stroke (N = 30) with a stroke onset >6 months and <18 months. INTERVENTIONS: Twenty-eight minutes of leg cycling with functional electrical stimulation with linear or interval patterns of timing applied to the peroneal and biceps femoris muscles, 3 times/week for 4 weeks. MAIN MEASURES: Timed 10-Meter Walk Test and Functional Ambulation Classification were the primary outcome measures. The Modified Modified Ashworth scale, active range of motion, Timed Up and Go Test, and Single Leg Stance Test were the secondary outcome measures. Evaluation was performed at baseline, after 4, and after 8 weeks. RESULTS: Thirty participants completed the 4-week intervention (interval group, n = 16; linear group, n = 14). The Functional Ambulation Classification, Timed 10-Meter Walk Test, and the Timed Up and Go Test improved significantly in both groups. The Modified Modified Ashworth scale scores for quadriceps and plantar flexion statistically decreased after 4-weeks in the interval group. Significant group-by-time interaction was shown for Timed Up and Go Test (p = 0.003, np2=0.228), knee flexion active range of motion (p < 0.001, np2=0.256) and dorsiflexion active range of motion (p < 0.001, np2=0.359). Modified Modified Ashworth scale and active range of motion in both the ankle and knee improved significantly in the interval group. CONCLUSIONS: The functional electrical stimulation with cycling protocols improved the Functional Ambulation Classification, Timed 10-Meter Walk Test, active range of motion, Timed Up and Go Test, and Modified Modified Ashworth scale. An interval protocol of timing was more effective than the linear protocol in terms of spasticity and active range of motion.Implications for rehabilitationCycling + functional electrical stimulation training with an interval pattern of timing seems superior to cycling + functional electrical stimulation training with a linear pattern.Interval protocol has positive effects on spasticity and range of motion after 12 sessions in patients post stroke.Cycling + functional electrical stimulation improves functional mobility and speed in stroke survivors and the effects of this intervention lasted in follow-up assessment after one month.

Concurrent impact of bilateral multiple joint functional electrical stimulation and treadmill walking on gait and spasticity in post-stroke survivors: a pilot study.

Background: Stroke causes multi-joint gait deficits, so a major objective of post-stroke rehabilitation is to regain normal gait function. Design and Setting: A case series completed at a neuroscience institute. Aim: The aim of the study was to determine the concurrent impact of functional electrical stimulation (FES) during treadmill walking on gait speed, knee extensors spasticity and ankle plantar flexors spasticity in post-stroke survivors. Participants: Six post-stroke survivors with altered gait patterns and ankle plantar flexors spasticity (4 = male; age 56.8 ± 4.8 years; Body Mass Index (BMI) 26.2 ± 4.3; since onset of stroke: 30.8 ± 10.4 months; side of hemiplegia [L/R]: 3:3) were recruited. Intervention: Nine treatment sessions using FES bilaterally while walking on a treadmill. Main Outcome Measures: Primary outcome measures included the Modified Modified Ashworth Scale (MMAS), Timed Up and Go test (TUG), 10-m walking test, gait speed, and Functional ambulation category (FAC). Secondary outcome measures included the Step Length Test (SLT), and active range of motion (ROM) of the affected ankle and the knee. Measurements were taken at baseline (T0), at the end of last treatment (T1), and 1 month after the final treatment session (T2). Results: The TUG, 10-m walking test, gait speed, FAC, active ROM, and SLT all significantly improved following treatment (P< .05), while ankle plantar flexors spasticity (P = .135), and knee extensors spasticity (P = .368) did not show any significant decrease. Conclusions: A short duration of bilateral FES in conjugation with treadmill walking contributed to significant improvement in gait speed, functional mobility, functional ambulation, range of motion and step length in post-stroke survivors. In contrast, no significant decreases were identified in the spasticity of the ankle plantar flexors and knee extensors muscles.

Experimental study of prosthesis modifications based on passive dynamic walking model: A limit cycle stability analysis.

The aim of the current study was to examine the effect of asymmetric prosthesis derived from the passive dynamic walking (PDW) concept on dynamic stability and symmetry in unilateral transfemoral amputees. Seventeen transfemoral amputees were asked to walk on 77.8 m in preferred speed under four conditions: 1) no added mass, 2) the knee joint relocated downwards by 18% of the total shank length, shank mass decreased by 68%, thigh mass increased by 7%, 3) the knee joint relocated downwards by 37% of the total shank length, shank mass decreased by 68%, thigh mass increased by 7% and 4) thigh mass increased 17%, shank mass decreased by 38%. Trunk accelerations were recorded by a triaxle accelerometer, attached at the L3 level of spine. For each condition, stability (orbital and local), intra-limb step length and step time variability, step length and step time symmetry, were estimated from the vertical acceleration. Our findings showed no significant change in the orbital stability (P = 0.627) and the local stability (P = 0.748). In addition, no significant difference was found in the step length symmetry (P = 0.891), intra-limb step length variability (P > 0.234), the step time symmetry (P = 0.960) and intra-limb step time variability (P > 0.847) with the new prosthetic configurations. Our empirical findings indicate that contrary to the modeling predictions, manipulating physical parameters does not improve gait pattern in terms of stability, variability and symmetry in transfemoral amputees. It suggests that proposed modifications based on PDW cannot be directly applied to real human conditions without further elaborations.

Development of a GC-MS Method for Determination of Various Polycyclic Aromatic Hydrocarbons in Iranian Traditional and Semi-industrial Taftoon Bread.

This research reports a validated multi-residue method based on gas chromatography coupled mass spectrometry technique for analysis of 24 Polycyclic Aromatic Hydrocarbons (PAHs) in traditional and semi-industrial Taftoon bread using QuEChERS sample preparation. Matrix effect studies were performed by comparing the slopes of solvent based standard calibration curves and spiked calibration curves. Due to enhancement or suppression effects of matrix, validation of the method was performed using spiked calibration curves. In the concentration range of 10-500 ng/g, the calibration curves for each analyte was linear with a determination coefficient (R2) of 0.991-0.999. The Detection and quantitation limits for the studied PAHs were calculated 0.14-1.49 ng/g and 0.46-4.91 ng/g. The average recoveries for three spiked levels (25, 50 and 200 ng/g), were in the range 77-103% (n = 27), with a satisfactory precision (RSD < 20%). Analysis of Taftoon bread samples using the validated method showed that three compounds; NPH, PHE and ANT were found in 37 (35.2%) samples and in the term of traditional and semi- industrial samples the occurrence of mentioned PAHs were 36.1% and 33.3%, respectively. According to the findings, we proposed that direct flame exposure in gas oven during baking of Taftoon bread could produce PAHs in bread samples.

The impact of modified exercise and relaxation therapy on chronic lower back pain in office workers: a randomized clinical trial.

This study aimed to evaluate the effectiveness of a modified package of exercise therapy combined with relaxation on pain intensity, range of motion (ROM), anxiety, and quality of life (QoL) in office workers with chronic lower back pain. In this clinical trial, 72 office workers aged 20 to 50 years with chronic low back pain were randomized to one of four groups including; group 1, exercise therapy; group 2, psychotherapy (relaxation therapy); group 3, modified protocol (exercise therapy followed by relaxation therapy); group 4, control group (no intervention). Participants exercised 3 times weekly for 6 weeks for 40-45 min of exercise/relaxation. Pain intensity, ROM, anxiety, and QoL were evaluated at baseline, 6 weeks, and 12 weeks after the end of the intervention. Results showed significant decreases in pain intensity and anxiety in the three experimental groups compared to the control group. The three intervention groups indicated a significant decrease in pain intensity and anxiety after 6 and 12 weeks. ROM significantly improved in the exercise therapy and the modified protocol over time (after 6 and 12 weeks). A significant difference in QoL was found between the groups, with the greatest improvement found in the psychotherapy and modified protocol groups. This therapeutic package (including exercise movements and psychological interventions) was found to have a superior effect on pain intensity, ROM, anxiety, and QoL after 6 and 12 weeks compared to other interventions (only exercise and psychotherapy).

Effects of kinesiotaping on knee osteoarthritis: a literature review.

The purpose of this review was to determine the current evidence-base for the efficacy of kinesiotaping in patients with osteoarthritis. Searching was undertaken using MEDLINE, Embase, Scopus, Web of Science, Physiotherapy Evidence Database (PEDro) from 2007 to 2018. The target terms included within our search criteria were "kinesiotape," "osteoarthrites," "knee pain," "adults," and "geriatric." Current findings indicate that kinesiotaping can be considered a useful method for decreasing pain without any side effects in patients with osteoarthritis. The search yielded 1,062 articles and finally seven studies met inclusion criteria. However, there are a limited number of appropriately powered, robustly designed studies. Further research is required to fully understand the short- and longer-term impact of kinesotaping in patients with osteoarthritis.

Occurrence of multiclass pesticide residues in tomato samples collected from different markets of Iran.

BACKGROUND: Pesticides are a reason for popular concern due to their possible unfavorable results on human safety. Most pesticide residues are present in food owing to the direct application of a pesticide to a crop. The aims of this study were; development a multiresidue method for analysis of 81 pesticides in tomato using GC/MS, and detection and quantitation of the studied pesticides in tomato samples gathered from various stores of Iran. METHODS: The pesticides were assessed concurrently in a single run applying GC/MS after extraction with QuEChERS method. Homogenized tomato samples were weighed into centrifuge tubes. The studied pesticides were extracted using acetonitrile, followed by the addition of a mixture of anhydrous magnesium sulfate and sodium acetate. In order to remove excess water and other components of tomato a combination of primary secondary amine and magnesium sulfate was applied, and then the extracted components were analyzed by GC-MS. RESULTS: The calibration curves for all analytes were linear in the range of 20-200 ng/g with a determination coefficient (R2) in the range between 0.993 and 0.999. The LODs and LOQs were in the range between 2.5-6.7 and 7.5-20 ng/g respectively, and the mean recoveries obtained for three fortification levels (25,50 and 100 ng/g -five replicates each) were 72-116% with RSD < 20%. Six residues were found in 31 (20.7%) samples. Iprodione was the most common detected residues (6.0%), followed by permethrine (4.7%), esfenvalerate (4.7%), chlorpyrifos (3.3%), diazinon (2.0%), and penconazole (1.3%). CONCLUSIONS: Among the detected pesticides, only Iprodione, permethrine, chlorpyrifos and diazinon are registered for tomato production in Iran. With exception of Chlorpyrifos and diazinon the concentrations of iprodione and permethrine were found below the maximum residue levels (MRLs) established by Iranian National Standard Organization (INSO). Esfenvalerate and penconazole are not registered for tomato production in Iran. Therefore, it is necessary to control and management of their residues in tomato.