Respiratory Function Assessment through Kinematic Analysis of Chest Wall Movements: Effects of Position and Gender.

Background: The effect of position and gender on chest movements and respiratory volumes is controversial and investigated in only a few studies. Objective: This study aimed to investigate the effects of position and gender on the breathing pattern during four different positions in healthy individuals. Material and Methods: In this cross-sectional study, twenty-eight (14 males, 14 females) healthy individuals participated aged 20-45 years. The optoelectronic plethysmography (OEP) method was used for the three-dimensional evaluation of chest wall motions and the compartmental analysis of the breathing pattern in supine, sitting, standing, and active straight leg raised (ASLR) positions. Volume changes in different parts of the chest wall were also measured. Results: Position affected total and compartmental respiratory volumes in both genders. Respiratory volumes decreased in the supine position compared to sitting and standing. Total and abdominal respiratory volumes also decreased in females when comparing supine positions with the ASLR. A higher pulmonary rib cage contribution was identified in females, and males exhibited higher abdominal rib cage volume compared with females. Conclusion: The breathing pattern was affected by position and gender, and the respiratory volumes increased in more upright positions, perhaps due to a greater gravitational load. The ASLR decreases the respiratory volume, which is probably due to increased postural demand.

The sono-elastography evaluation of the immediate effects of neurodynamic mobilization technique on median nerve stiffness in patients with carpal tunnel syndrome.

OBJECTIVES: The stiffness of median nerve increases in carpal tunnel syndrome (CTS) even at mild stage of syndrome which could be regarded as a diagnostic criterion. The aim of this study was to evaluate the immediate effects of neurodynamic technique on median nerve stiffness and cross-sectional area (CSA) at wrist and elbow in individuals with CTS. MATERIAL AND METHODS: It was a quasi-experimental study. Twenty patients were recruited for this study. They were included if aged 18-65 years and diagnosed with CTS based on electrodiagnostic and clinical findings. The exclusion criteria were previous surgeries at wrist or elbow. Patients were assessed by shear wave sono-elastography before and immediately after one session of neurodynamic mobilization technique (NDM). The primary outcome measure was the stiffness of the median nerve at wrist and the secondary outcomes were nerve stiffness at elbow and CSA of nerve at wrist and elbow. RESULTS: Median nerve stiffness and CSA decreased significantly at wrist immediately after a session of NDM. These parameters also decreased at elbow but were not statistically significant. CONCLUSION: One session of NDM reduced the stiffness and CSA of median nerve at wrist in patients with CTS as detected by sono-elastography verifying that sono-elastography is able to quickly detect the immediate biomechanical changes of the median nerve.

The effect of perturbation training with and without applying the dry needling on leg muscles in patients with chronic ankle sprain.

INTRODUCTION: Ankle sprain is a common musculoskeletal injury that leads to recurrent instability. Repeated ankle sprain can be a mechanism for creating trigger point. Proper treatment of trigger points, in addition to preventing recurrence of sprains, may reduce pain and improve muscle function. This improvement can be the result of preserving the surrounding tissues from excessive pressure. OBJECTIVE: Investigate the added value of dry needling into perturbation training protocol for chronic ankle sprain. DESIGN: Randomized clinical trial; assessor-blind; before and after comparison. SETTING: Treatment of patients referred to the institutional rehabilitation clinics. MAIN OUTCOME MEASURE(S): Functional assessment with FAAM questionnaire score, Pain with NPRS scale, ankle instability severity with Cumberland tool. METHODS: Twenty-four patients with chronic ankle instability participated in this clinical trial and were randomly divided into two groups. Intervention was 12 sessions in which one group received only perturbation training and the other group received perturbation training along with dry needling. Repeated measures ANOVA was used to investigate the effect of treatment. RESULTS: Data Analysis showed significant difference in NPRS and FAAM and Cumberland score before and after treatment in each group (P < 0.001). Comparison of the results between the groups did not show any significant difference (P > 0.05). CONCLUSION: The findings showed that adding dry needling technique to the perturbation training does not have greater effects on the pain and function of patients with chronic ankle instability.

Comparison between dry needling plus manual therapy with manual therapy alone on pain and function in overhead athletes with scapular dyskinesia: A randomized clinical trial.

Muscles' trigger points can induce scapular dyskinesia (SD) which interferes with overhead athletes' professional training. We aimed to evaluate effects of dry needling (DN) alone and plus manual therapy (MT) on pain and function of overhead athletes with SD. 40 overhead athletes (15 male, 25 female) aged 18-45 with at least 3 points Numeric Rating Scale (NRS) pain intensity during training were recruited and randomly allocated to the treatment group: MT followed by DN on trigger points of Subscapularis, Pectoralis minor, Serratus anterior, upper and lower Trapezius muscles; or the control group: MT alone. The effect of shoulder trigger points DN plus MT with MT alone on pain, function, Pain Pressure Threshold (PPT) and SD in athletes with SD were compared. Both the examiner and the therapist were blinded to group assignment. Both groups were analyzed. Pain, disability and SD were improved in treatment group (P < .05). On the other hand, when only MT was applied, despite reduction in pain and disability (P < .001), scapular slide only improved in hands on waist position. Comparing the differences between groups showed a substantial reduction in pain (P < .001) and disability (P = .02) with significant improvement in scapular dyskinesia in treatment group (P = .02). Moreover, PPT significantly increased in the control group (P = .004). No adverse effects reported by the participants during this study. DN is an easy and applicable method that can synergistically reduce pain, disability and dyskinesia when it is combined with manual techniques to treat shoulder dysfunctions.

Comparison of the effect of two different types of dry-needling techniques on subacromial impingement syndrome.

INTRODUCTION: Infraspinatus is one of the main muscles that is involved in the subacromial impingement syndrome. Dry needling and routine physical therapy can improve this syndrome. However, the dry needling technique is not well defined. DESIGN: randomized controlled clinical trial, single-blind study. METHOD: Sixty-six patients diagnosed with shoulder impingement syndrome were recruited and randomly divided into three groups. INTERVENTIONS: In 1st group; patients received deep dry needling technique in addition to routine physical therapy, in Hong's group; patients received Hong's dry needling technique in addition to routine physiotherapy and in third group; patient just received routine physical therapy. MAIN OUTCOME MEASURE(S): Before, immediately after and 4 weeks after the intervention, pain, disability and the pressure pain threshold were measured. RESULTS: The findings of this study indicated that in DDN group, pain and disability reduction was significantly more than two other groups. Although, the pressure pain tolerance increased in all three groups after treatment, but the increase between groups was not significantly different. All study groups showed reduction in pain, while there was no significant difference between the three groups. CONCLUSION: Pain and disability reduction in the DDN group compared to the other two groups may reveal the treatment with deep dry needling technique along with routine physiotherapy is more effective than receiving dry needling with Hong's technique or routine physiotherapy alone. However, there was no significant difference between the three groups in pressure pain tolerance threshold and pain reduction.

Kinematic cluster analysis of the crouch gait pattern in children with spastic diplegic cerebral palsy using sparse K-means method.

BACKGROUND: Crouch gait pattern is a common gait pattern in children with diplegic cerebral palsy with excessive knee flexion throughout stance phase. Few studies have grouped this pattern of gait and usually have examined only the features of gait in the sagittal plane and mostly lower extremities without considering pelvis and trunk behavior. Studies usually categorize the gait pattern according to important variables from the researcher's point of view. Sparse K-means is high dimensional clustering methods that perform clustering and variable selection simultaneously even with low sample size and large number of variables. Our aim was to define existing clusters of crouch gait pattern in children with spastic diplegic cerebral palsy. METHODS: Cluster analysis was applied on the lower extremity, pelvis and trunk gait kinematics data of 64 limbs of children with crouch gait pattern and 64 limbs of typically developing children. Eighty-nine kinematic variables were used as input variables for clustering. FINDINGS: Four clusters of crouch gait pattern were defined. Sparse K-means identified influential variables and identified the knee and hip flexion as a major factor in clustering. Kinematic of the trunk, pelvis and ankle was determined in each cluster. Trunk and pelvis kinematic features were strongly correlated with the knee and hip joint flexion severity. INTERPRETATION: Obtained clusters were confirmed observationally. With increasing knee flexion, the kinematic of the trunk and pelvis were further away from the patterns of typically developing individuals. The clusters ranking appear to be reasonable based on the crouch severity.

The immediate effect of lumbopelvic manipulation on knee pain, knee position sense, and balance in patients with patellofemoral pain: A randomized controlled trial.

BACKGROUND: Patellofemoral pain (PFP) is a common musculoskeletal disorder. Quadriceps and core muscle neuromuscular control impairments are frequently associated with PFP. Lumbopelvic manipulation (LPM) has been shown to improve quadriceps and core muscle activation and decrease their inhibition, but changes in balance and knee joint position sense (JPS) after this intervention remain unknown. OBJECTIVE: To determine whether LPM decreases knee pain and JPS error and increases balance performance in patients with PFP. DESIGN: Randomized controlled trial. SETTING: Biomechanics laboratory at a rehabilitation science research center. METHODS: Forty-four patients with PFP participated in this study that randomly divided into two equal groups. One group received LPM and the other received sham LPM (positioning with no thrust) in a single session. At baseline and immediately after the intervention, the outcomes of pain using a visual analog scale, balance using the modified star excursion balance test (mSEBT), and JPS at 20° and 60° of knee flexion using a Biodex dynamometer. RESULTS: There was a statistically significant improvement in pain, balance control (anterior direction) and JPS in the LPM group immediately after the intervention. In addition, we observed significant differences between groups in pain, balance control (anterior direction) and JPS at 60° of knee flexion immediately after the intervention. CONCLUSION: A single session of LPM immediately improved balance control, knee JPS, and pain in patients diagnosed with PFP. CLINICAL REHABILITATION IMPACT: Findings suggest that LPM may be used as a therapeutic tool for immediate improvement of symptoms of PFP. However, more research is needed to determine long term results.

Self-confidence and attitude of acute care nurses to the presence of family members during resuscitation.

AIM:: the present study aimed to assess the relationship between attitude to the presence of family members during cardiopulmonary resuscitation and confidence of acute care nurses in performing cardiopulmonary resuscitation in the presence of family. METHODS:: this descriptive-analytical study was conducted on nurses working in acute care units (intensive care unit, coronary care unit, and emergency department) in Iran in 2017. A total of 150 nurses entered the study by convenience sampling. Data were collected on nurses' attitude towards the presence of family scale and nurses' self-confidence in presence of family scale. RESULTS:: of the 150 participants, 48 (32%) were men and 102 (68%) were women. Total mean score of attitude was 67±10.4 (obtained scores by nurses ranged from 32 to 100). Total mean score of self-confidence was 53.86 ±11.7 (obtained scores by nurses ranged from 23 to 81). Pearson correlation test showed a significant negative relationship between nurses' attitude toward presence of family members during cardiopulmonary resuscitation and their self-confidence (rr=-0.45, p=0.001). CONCLUSION:: the present study showed that nurses with a higher self-confidence have a more positive attitude toward presence of family members during cardiopulmonary resuscitation. Given the importance of the subject, it should be considered by nursing managers and planners.

Investigation of a new double-stage aerobic-anoxic continuous-flow cyclic baffled bioreactor efficiency for wastewater nutrient removal.

Nitrogen and phosphorus are among the potential pollutants of receptive water sources entering into these water sources via sewage, which are not sufficiently treated. The purpose of this study is to investigate the efficiency of a new two-stage aerobic-anoxic continuous-flow baffled cycling reactor (CFBCR) to reduce nitrogen and phosphorus load from wastewater. Therefore, a double-stage baffled reactor was used in which the second part was integrated with the settling part causing the sludge to be spontaneously returned to the second reservoir. Additionally, the effect of different concentrations of chemical oxygen demand (COD) of 400-800 mg/L, ammonia of 40-60 mg/L, phosphate of 12-20 mg/L, internal rate of return of 100-200% and the retention time of 18-30 h was investigated. Furthermore, to investigate the performance of this reactor, four phases with different aeration and mixing conditions were designed. The percentage of ammonia removal with influent concentration of 40 mg/L in phase 2 with intermittent mixing and one-hour aeration time was 98.7%; effluent nitrate average concentration was 8.4 mg/L NO3-N, and phosphate removal percent was 83%. The best nutrient removal efficiency was with the retention time of 24 h and internal return rate of 150%. In conclusion, CFBCR reactor with continuous influent and effluent and reduction of the need for sludge return, has the potential to be applied to remove nutrients from wastewater.

Comparison between massage and routine physical therapy in women with sub acute and chronic nonspecific low back pain.

OBJECTIVE: The aim of this study was to investigate the comparison of massage therapy and routine physical therapy on patients with sub acute and chronic nonspecific low back pain. METHODS AND MATERIALS: Thirty volunteer female subjects with a sub acute or chronic nonspecific low back pain were randomly enrolled in two groups, massage therapy and routine physical therapy. After massage application, the hamstring and paravertebral muscles stretching and also stabilizing exercises were prescribed. In the routine physical therapy group, TENS, US and vibrator were used besides exercises. Pain intensity according to Numerical Rating Scale, functional disability level in accordance to Oswestry Disability Index, and modified Schober test, for measurement of flexion range of motion, before and after ten sessions of treatment were used to evaluate the effectiveness of the treatment. RESULTS: Pain intensity, Oswestry Disability Index and flexion range of motion had shown significant differences before and after intervention in both groups (p<0.001). The statistical analysis revealed that the massage therapy had significantly improved the pain intensity and Oswestry Disability Index compared to routine physical therapy (p=0.015, p=0.013 respectively), but the range of motion changes were not significant between two groups (p=1.00). CONCLUSION: It can be concluded that both massage therapy and routine physical therapy are useful for sub acute and chronic nonspecific low back pain treatment especially if accompanied with exercise. However, massage is more effective than other electrotherapy modalities, and it can be used alone or with electrotherapy for the treatment of patients with low back pain.

The role of nitric oxide in spatial memory stages, hippocampal ERK and CaMKII phosphorylation.

Nitric oxide (NO) is an important intercellular messenger in the control of physiologic functions. It is synthesized by 3 different nitric oxide synthase enzymes (NOS). Uses of non-selective NOS inhibitor (L-NAME) have shown that NO is involved in neuronal plasticity and memory. This study aimed to determine the differential role of NO in spatial memory formation steps. In addition, regarding the roles of ERK and CaMKII in hippocampal plasticity, the hippocampal ERK and CaMKII activities were assessed to identify the effect of L-NAME on those proteins during each phase of memory. Adult male Sprague-Dawely rats weighing 220-280 g were trained in a single session consisting of 8 trials. To evaluate the effect of L-NAME on acquisition, L-NAME (3 or 10 mg/kg/i.p.) was administered 30 min before training. To assess its effect on the consolidation phase, L-NAME (3 or 10 mg/kg/i.p.) was injected immediately after training and a probe test was carried out 24 h later to analyse memory retention. To determine its effect on memory retrieval L-NAME (3 or 10 mg/kg/i.p.) was injected 30 min before probe trial which was conducted 24 h after training. The hippocampi were isolated after behavioural studies and western blotting analysis on hippocampal lysates was performed to illustrate the levels of phosphorylated ERK and CaMKII. The results showed that pre-training administration of L-NAME in 10 mg/kg but not 3mg/kg deteriorates acquisition. Post-training and pre-probe administration of L-NAME in 10 mg/kg but not 3 mg/kg impaired animal's performance in probe test. Additionally L-NAME treatment decreased the amount of phosphorylated (activated) ERK and CaMKII in the hippocampus. This study showed that endogenous nitric oxide is involved not only in all stages of memory, but also in ERK and CaMKII activation in the hippocampus during all 3 stages of memory.

The effects of transcutaneous electrical nerve stimulation on joint position sense in patients with knee joint osteoarthritis.

OBJECTIVE: To study the effects of transcutaneous electrical nerve stimulation (TENS) on joint position sense (JPS) in knee osteoarthritis (OA) subjects. METHODS: Thirty subjects with knee OA (40-60 years old) using non-random sampling participated in this study. In order to evaluate the absolute error of repositioning of the knee joint, Qualysis Track Manager system was used and sensory electrical stimulation was applied through the TENS device. RESULTS: The mean errors in repositioning of the joint, in two position of the knee joint with 20 and 60 degree angle, after applying the TENS was significantly decreased (p < 0.05). CONCLUSION: Application of TENS in subjects with knee OA could improve JPS in these subjects.

Silicone intubation for nasolacrimal duct stenosis in adults: monocanalicular or bicanalicular intubation.

PURPOSE: The purpose of this study was to compare the success rate of monocanalicular versus that of bicanalicular silicone intubations of the nasolacrimal duct for nasolacrimal duct stenosis (NLDS) in adults (patent nasolacrimal duct with resistance to positive-pressure irrigation). MATERIALS AND METHODS: In a prospective randomized clinical trial, 52 eyes of 38 patients with NLDS underwent either monocanalicular silicone intubation (MCI) (n = 26 eyes) or bicanalicular silicon intubation (BCI) (n = 26 eyes). All procedures were performed by 1 oculoplastic surgeon. Tube removal was planned for 3 months postoperatively. Treatment success was defined as the complete resolution of epiphora or intermittent epiphora with normal dye disappearance test at 6 months after tube removal. RESULTS: The surgical outcome was assessed in 25 eyes with MCI and 21 eyes with BCI. The mean (SD) age of treatment was 52.7 (18.6) years for MCI and 49 (18.8) years for BCI. Treatment success was achieved in 19 of 25 eyes (76%) in the MCI group compared with 16 of 21 eyes (76.2%) in the BCI group. Differences between the 2 groups proved to be not significant (P = 0.9). The only complication was peripunctal pyogenic granuloma in 2 eyes with BCI. CONCLUSIONS: Both MCI and BCI were successful in a similar percentage of patients with NLDS. The main advantages of the former technique were simple insertion and easy removal of the tube.

The effect of trigger point management by positional release therapy on tension type headache.

OBJECTIVE: The aim of this study was to compare the effectiveness of trigger points' management by Positional Release Therapy (PRT) and routine medical therapy in treatment of Tension Type Headache. BACKGROUND: Tension Type Headache is the most frequent headache with the basis of myofascial and trigger point disorders. PRT is an indirect technique that treats trigger points. METHOD: 30 Patients with active trigger points in cervical muscles entered to the study. They were randomly assigned to PRT or medical therapy group. Headache frequency, intensity and duration and tablet count were recorded by use of a daily headache diary. Sensitivity of trigger points was assessed by numeric pain intensity and by use of a digital force gauge (FG 5020). RESULTS: Both groups showed significant reduction in headache frequency and duration and tablet count after treatment phase. However, the reduction of study variables was persisted only in PRT group after follow up phase. There was no significant reduction in headache intensity, neither in PRT and nor in medication group. Sensitivity of trigger points was significantly reduced. In comparison of the two study groups, there was no significant difference in headache frequency, intensity, duration and tablet count (p> 0.05). CONCLUSION: Both procedures were equally effective according to the study. Thus, PRT can be a treatment choice for patients with T.T.H.

Agmatine protects against scopolamine-induced water maze performance impairment and hippocampal ERK and Akt inactivation.

Cholinergic brain activity plays a significant role in memory. Scopolamine a muscarinic cholinergic antagonist is known to induce impairment in Morris water maze performance, the task which is mainly dependent on the hippocampus. It is suggested that hippocampal ERK and Akt activation play roles in synaptic plasticity and some types of learning and memory. Agmatine, a polyamine derived from l-arginine decarboxylation, is recently shown to exert some neuroprotective effects. This study was aimed to investigate if agmatine could reverse scopolamine-induced memory impairment and possible hippocampal ERK and Akt activity alteration. Adult male Sprague-Dawley rats weighing 200-250 g were randomly assigned into 5 groups. The animals were trained for 3 days in Morris water maze and in day 4 their memory retention was assessed in probe trial which was consisted of a 60 s trial with no platform. Scopolamine (1 mg/kg/ip) or saline were injected 30 min and agmatine (20 or 40 mg/kg/ip) was administered 60 min before each session. The hippocampi were isolated after behavioral studies and western blotting studies on hippocampal lysates were done to determine the levels of activated ERK and Akt. Scopolamine treatment not only impaired water maze learning and memory, but also decreased the amount of phosphorylated (activated) ERK and Akt. Agmatine pre-treatment prevented both the learning impairment and hippocampal ERK and Akt inactivation induced by scopolamine. It seems that agmatine may act as a candidate substance against amnesia.