A controlled clinical trial investigating the effects of stretching and compression exercises on electromyography of calf muscles in chronic LBP patients with a deep gluteal syndrome.

BACKGROUND: In deep gluteal syndrome (DGS), the piriformis muscle could impinge the sciatic nerve. The FAIR (flexion adduction internal rotation) test is a provocation test used to identify sciatic nerve irritation caused by this muscle. Compression and stretching exercises are usually prescribed to treat this syndrome. The aim of this study was to compare the effects of these two treatments on surface electromyography (sEMG) of the gastrocnemius and tibialis anterior in patients with low back pain (LBP) and DGS. MATERIALS AND METHODS: Forty-five participants were allocated to three groups of stretching exercise, compression or control. In addition to 15 min of heat and 15 min of electrical nerve stimulation for pain relief, participants in the compression exercise (CE) group received self-compression exercise, those in the stretching exercise (SE) group received self-stretching exercise and those in the control group received no extra interventions. For the two intervention groups, three sets of two minutes of exercise with two minutes of rest in between were applied. The sEMG amplitude values of the gastrocnemius and tibialis anterior muscles of the affected buttock side of any one group while performing the FAIR test were compared to the others. Pain and disability were assessed and the changes were compared between the two groups. RESULTS: After the intervention period, no group demonstrated a change in the sEMG of the gastrocnemius or tibialis anterior muscles (p > 0.05). There was no difference in the change in this variable between groups (Mean difference (95% CI) of gastrocnemius was ranged over= -4.04 to 7.72 (-19.44 to 23.14); p = 0.603); (Mean difference (95% CI) of tibialis anterior muscles was ranged from - 2.44 to -6.43 (-18.28 to 9.31); p = 0.550).; Pain and disability also decreased significantly in all three study groups (p < 0.05). However, only the disability of patients who performed stretching exercises improved compared to the compression exercise group (Mean difference (95% CI) = -12.62 (-20.41 to -4.38); p = 0.009). CONCLUSION: Neither stretching nor compression exercises altered the sEMG of the gastrocnemius and tibialis anterior muscles in patients with DGS. Furthermore, performing stretching exercises improved disability compared to the other interventions. TRIAL REGISTRATION: The trial was retrospectively registered in the Iranian Registry of Clinical Trials ( www.irct.ir ) on 10/01/2017 as IRCT201604178035N4. URL of the record: https://en.irct.ir/trial/8473 .

The Importance of Personal and Familial Factors on Breastfeeding Intention and Practices, and Postpartum Distress during the Pandemic: A Longitudinal Observational Study.

BACKGROUND: The COVID-19 pandemic has significantly impacted pregnant and breastfeeding women. Both low- and high-risk groups adopted preventive approaches such as mask-wearing and handwashing to slow down and prevent viral transmission during critical periods that may affect mother-child interactions. METHODS: A longitudinal observational study was conducted with primiparous women recruited using convenience sampling from the postpartum care ward of Afzalipour Teaching Hospital in Kerman from August 1, 2020 to March 30, 2021. The research questionnaires included demographic information, preventive behaviors, breastfeeding intention and practices, postpartum distress, and Edinburgh Postpartum Depression Scale. All the questionnaires were self-reported online in three stages: before discharge from the postpartum ward, the first month after delivery, and the third month after delivery. RESULTS: A Total of 160 primiparous women were included. The results showed significant changes in preventive behaviors and postpartum distress levels during the study. Breastfeeding intention and practices were negatively affected by postpartum distress (P = 0.034), unwanted pregnancies (P = 0.009), and cesarean delivery (P < 0.001). Postpartum distress was directly affected by the presence of depression (P < 0.001). Preventive behaviors at discharge were significantly associated with postpartum distress three months after delivery (P = 0.013). The study also found an association between women's and partner's education, unwanted pregnancy, and cesarean delivery that determined postpartum distress. CONCLUSIONS: Pandemic restrictions did not affect breastfeeding intentions or practices, possibly due to sufficient social and family support during the pandemic. However, robust guidelines are required to increase enable women's access to specializede care to cope with future pandemics, particularly during the first few weeks after childbirth.

A systematic review of conservative and surgical treatments for deep gluteal syndrome.

BACKGROUND AND OBJECTIVE: Conservative and surgical treatments, are recommended as the primary treatment in the management of patients diagnosed with deep gluteal syndrome; but evidence supporting superiority of one treatment over another is lacking. The aim of this review is to systematically review the effectiveness of treatments. DATABASES AND DATA TREATMENT: MEDLINE, EMBASE, Web of Science, Scopus, AMED, Cochrane Library (Central Register of Controlled Trials), and PEDro were screened (to 24 July 2019). Risk of bias of trials and surgical case series were assessed using the Cochrane risk of bias tool and Joanna Briggs Institute Critical appraisal checklists, respectively. Outcomes were reductions in pain or disability. For each outcome, the minimum clinically important difference (MCID) was calculated. A narrative synthesis was performed. RESULTS: Out of 909 records, thirteen studies with 508 patients were included, eight RCTs with 336 patients and 5 case series with 172 patients. Conservative modalities were: infiltration into muscle of steroid, botulinum toxin, thiochilcoside and colchicine. There was one RCT and five case series of surgery. Only three trials reached an MCID in pain reduction for the intervention. The five surgical studies reached a before and after MCID. Only one study showed an MCID reduction in disability. The overall quality of evidence was low. CONCLUSION: Given the low quality of evidence, no single conservative treatment can be recommended over another. Clinicians should follow general guidelines on the management of back pain and sciatica for first line treatment, namely physiotherapy. Surgery may have a place for chronic cases.

The Effects of Aroma on Apnea Attacks and Oxygen Saturation Among Preterm Infants: A Systematic Review and Meta-Analysis:.

Researchers and clinicians need to be aware of procedures that are more adaptable to new and different environments in premature infants; therefore, it is important to conduct a comprehensive review of the effect of aromatherapy on apnea attacks and oxygen saturation (SpO2 ) in premature newborns. In this review, databases such as PubMed, Scopus, Web of Science, and Cochrane Library were systematically searched without language and time limitations up to November 1, 2022. Initially, 153 studies were founded, and after duplicate removal, title as well as full-text review, seven studies were enrolled in the final analysis. Studies indicated that aromatherapy with Rosa damascena, vanilla, and breast milk odors could significantly reduce apneas in preterm infants and improve SpO2 levels. Hence, aromatherapy could consider as an effective adjuvant treatment for the reduction of apnea attacks among preterm infants.

The effects of hydroxychloroquine on pregnancy outcomes in infertile women: a systematic review and meta-analysis.

A promising strategy for controlling repeated implantation failure (RIF) may be the use of hydroxychloroquine (HCQ). To the best of our knowledge, no systematic review has been conducted on the effects of hydroxychloroquine on pregnancy outcomes. A systematic research of the following electronic databases was conducted: Cochrane, EMBASE-Ovid, PubMed, Web of Science, and Scopus from inception to December 2021, using the following keywords [hydroxychloroquine] AND [infertility]. Fertilization and rate of live birth were significantly higher in the HCQ+ prednisone (PDN) group than in the PDN alone group. However, the abortion rate was not different between the two groups. The meta-analysis of two studies revealed no statistical significance between the PDN group and HCQ+PDN group regarding clinical pregnancy rate (OR=.14 [95%CI: 0.4-4.370]; heterogeneity; P=0.13; I2=54%; random effect model) and implantation rate (OR=1.99 [95%CI: 0.94-4.2]; heterogeneity; P=0.37; I2=0%; fixed-effect model). While HCQ may help improve fertilization and live birth rates, adding it to prednisone did not improve overall pregnancy outcomes. This systematic review should be used with caution due to the small size, study design, and difference in the studies' population.

Hematological parameters and X-ray exposure among medical radiation workers: a systematic review and meta-analysis.

BACKGROUND: The aim of this study was to explore the effect of occupational exposure to X-ray on hematological parameters. RESEARCH DESIGN AND METHODS: A systematic search was conducted in the Scopus, PubMed, Web of Science, and Embase databases up to April 2020. The methodological quality was assessed by Joanna Briggs Institute (JBI) Critical Appraisal Checklist . The random-effects model was used to estimate the effect size (standard difference in means (SDMs)). RESULTS: Out of 1750 identified citations, ten studies met the inclusion criteria The overall effect size did not show any significant difference between the two groups (SMDs ranged from -0.382 ± 0.29 for white blood cells (WBC), 0.213 ± 0.40 for platelet, -0.323 ± 0.0.16 for mean corpuscular volume (MCV), 0.553 ± 0.41 for mean corpuscular hemoglobin concentration (MCHC), -1.615 ± 1.41 for monocyte, 0.418 ± 0.49 for lymphocyte (P-value>0.05). Only the effect size of red blood cells was significantly higher than that of the control group (SMD = 1.06 ± 0.28; 95% CI: 0.504, 1.615; P-value = 0.001). CONCLUSION: The long-term and low-dose radiation may have no significant effect on blood parameters. Future studies are suggested to use other tests such as dicentric chromosome assay (DCA), cytogenetic tests, and modern tests besides blood count parameters.

Effects of static stretching and strengthening exercises on flexion relaxation ratio in patients with LBP: A randomized clinical trial.

INTRODUCTION: Stretching and strengthening exercises are commonly used to improve muscle shortness. Consequently, the aim of this trial was to compare the flexion-relaxation response (electromyography activities of shortened hamstring and back muscles) in chronic nonspecific LBP patients. METHODS: In this randomized controlled clinical trial, forty-five eligible patients were randomly categorized into three groups; static stretching (n = 15), strengthening exercise in lengthened hamstring position (n = 15) and control (n = 15). All groups received conventional physical therapy for LBP and the two intervention groups received special exercise programs as well. Each group performed three treatment sessions for a week, a total of 12 sessions. The flexion-relaxation ratio (FRR) for knee and back muscles were assessed as the primary outcome measure. Pain and functional disability for participants were also assessed. RESULTS: The results indicated non-significant differences between the three groups regarding the changes of FRR (mean between-group differences ranged over 0.69 to 39.1; p > 0.05), pain and disability (mean between-group differences ranged over 0.15 to 5.96; p > 0.05). Within-group analysis for each group, revealed statistically significant improvement in the patients' score of either pain (mean within-group differences ranged over -27.20 to -35.76; p < 0.001) or disability (mean within-group differences ranged over -16.17 to 24.95; p < 0.001) as secondary outcomes. In other words, the scores of pain and disability decreased in all treatment groups as compared to the baseline. CONCLUSION: Neither static stretching nor strengthening exercises in lengthened hamstring position affected FRR more than the control group.

Effects of back exercises versus transcutaneous electric nerve stimulation on relief of pain and disability in operating room nurses with chronic non-specific LBP: a randomized clinical trial.

BACKGROUND: Low back pain (LBP) is one of the most common musculoskeletal disorders related to working. Due to the nature of nursing work, this problem is often seen in nurses, including those who work in the operating rooms. Depending on the cause, there are various surgical and non-surgical methods to treat LBP. The present study was aimed to compare the effect of two therapeutic methods of back exercises and transcutaneous electrical nerve stimulation (TENS) on the disability and pain of operating room nurses with LBP. METHODS: In this clinical trial forty-four eligible operating room nurses (30 women, 14 men, mean age: 37.86 ± 6.74) with chronic nonspecific LBP were randomly assigned to back exercises (including the strengthening and stretching exercise (n = 22)) or TENS (n = 22) groups by permuted block randomization method. These interventions were performed in both groups three sessions of 15 min per week for 6 weeks. The McGill pain questionnaire for back pain and the Oswestry disability questionnaire for disability assessment were completed immediately before and after the interventions. RESULTS: After 6 weeks, the mean of pain and disability decreased significantly in both groups compared to the baseline. Based on the results, significant decreases in the pain score (mean difference (95% CI): - 8.95 (- 12.77 to - 5.14); P-value < 0.001) and disability score (mean difference (95% CI): - 8.73(- 12.42 to - 5.03); P-value < 0.001) were revealed in the back exercises group after the intervention compared to the baseline. In addition, after the intervention in TENS group, the mean pain intensity and disability showed significant decrease, respectively (mean difference (95% CI): - 16.18 (- 19.81 to - 12.55); P-value < 0.001; mean difference (95% CI): - 15.82 (- 19.24 to - 12.40); P-value < 0.001). After adjusting for the baseline values, the TENS group had a significantly higher pain score reduction than the back exercises group (mean difference (95% CI): - 4.23 (- 8.03 to - 0.44); P-value =0.030; Cohen's d = 0.81). In addition, TENS led to a significant more decrease in the disability scores compared to the back exercises (mean difference (95% CI): - 3.99 (- 7.35 to - 0.64); P-value =0.021; Cohen's d = 0.73). Furthermore, a statistically significant time by group interaction effect on pain and disability score was found (interaction p < 0.001). CONCLUSION: Pain and disability were improved in both groups following 18 intervention sessions. However, pain and disability were improved to a greater extent in the TENS group than in the back exercises group. TRIAL REGISTRATION: The trial was retrospectively registered in the Iranian Registry of Clinical Trials ( www.irct.ir ) on 03/02/2019 as IRCT20180408039227N1 .

Accounting for Potential Unmeasured Confounding in the Association between Influenza vaccination and COVID-19 Hospitalization: Sensitivity Analysis Using E-value Method.

Background: Unmeasured confounding is the primary obstacle to causal inference in observational research. We aimed to illuminate the association between exposure to influenza vaccination (IV) within six months before contracting the coronavirus disease (COVID-19) and COVID-19 hospitalization in relation to unmeasured confounding using the E-value method. Materials and Methods: Information about 367 patients, 103 of whom (28.07 %) had received IV, and confounders included sex, age, occupation, cigarette smoking, opium, and comorbidities were collected. We estimated the interest association using the inverse probability weighted (IPW) method. There was no information on some potential unmeasured confounders, such as socioeconomic status. Therefore, we computed E-value as a sensitivity analysis, which is the minimum strength of unmeasured confounding to explain away an exposure-outcome association beyond the measured confounders completely. Results: IPW denoted 1.12 (95% CI: 0.71 to 1.29) times greater risk of COVID-19 hospitalization in patients exposed to IV than in unexposed individuals. Sensitivity analysis demonstrated that an E-value (95% CI) of 1.49 (1.90 to 2.15) is required to shift the RR and the corresponding confidence Interval (CI) lower and upper limits toward the null. Moreover, if they had been omitted, the most computed E-values for measured confounders were relatively larger than for unmeasured confounders. Conclusion: According to the context of the measured confounders, if they had been omitted, an E-value of 1.16 to 1.76, a weaker confounding could fully explain away the reported association, suggesting that no relationship exists between IV and COVID-19 hospitalization.

Influence of dietary L-carnitine and lysine-methionine levels on reproductive performance and blood metabolic constituents of breeder ducks.

The present study aimed to evaluate the influence of dietary supplementation of different levels of L-carnitine and/or lysine-methionine (Lys-Met) on reproductive performance of breeder ducks. Three L-carnitine (0, 75 and 150 mg/kg) and three lysine-methionine (100%, 110% and 120% above the NRC (Nutrient requirements of poultry, 1994, National Academy Press) recommendations) levels were fed to 180 breeder ducks (144 females and 36 males) in a completely randomized design for 49 days. Laying performance and reproductive traits were evaluated; additionally, uric acid, total protein total, triglycerides, total cholesterol, low-density lipoprotein, high-density lipoprotein, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were assessed. The Lys-Met above 100% NRC (Nutrient requirements of poultry, 1994, National Academy Press) recommendations with or without L-carnitine improved feed utilization (p < .05). Furthermore, Lys-Met above 100% recommendations without L-carnitine improved egg fertility and hatchability. Fertility and hatchability improved in breeders fed on L-carnitine with 120% Lys-Met (p < .05). Serum glucose increased and total cholesterol reduced on 100% Ly-Met without L-carnitine or 110% Ly-Met with 150 mg L-carnitine (p < .05). Glucose was reduced, while total cholesterol increased on 75 mg L-carnitine and 100% Lys-Met (p < .05). Increasing Lys-Met without L-carnitine reduced serum protein (p < .05). Albumin and ALT increased on 75 mg L-carnitine-100% Lys-Met and reduced on 150 mg L-carnitine-120% Lys-Met (p < .05). There were no interaction effects on globulin, uric acid and AST (p > .05). Thus, based on findings, breeder ducks responded to dietary Lys-Met more efficiently than L-carnitine; however, more research is needed to evaluate also economic aspects related to L-carnitine dietary supplementation.

Effects of multiple doses of gonadotropin-releasing hormone agonist on the luteal-phase support in assisted reproductive cycles: A clinical trial study.

BACKGROUND: The effect of adding gonadotropin-releasing hormone (GnRH) agonist on the luteal phase support in assisted reproductive technique (ART) cycles is controversial. OBJECTIVE: To determine the effects of adding multiple doses of GnRH agonist to the routine luteal phase support on ART cycle outcomes. MATERIALS AND METHODS: This clinical trial study included 200 participants who underwent the antagonist protocol at the Research and Clinical Center for Infertility, Yazd, Iran, between January and March 2020. Of the 200, 168 cases who met the inclusion criteria were equally divided into two groups - the case and the control groups. Both groups received progesterone in the luteal phase, following which the case group received GnRH agonist subcutaneously (0/1 mg triptorelin) zero, three, and six days after the fresh embryo transfer, while the control group did not receive anything. Finally, chemical and clinical pregnancy rates, number of mature oocytes, fertilization rate, total dose of gonadotropin, and the estradiol level were determined. RESULTS: The baseline characteristics were similar in both groups. No significant difference was observed between embryo transfer cycles. Clinical results showed that differences between the fertilization rate, chemical and clinical pregnancies were not significant. CONCLUSION: The results showed that receiving multiple doses of GnRH agonist in the luteal phase of ART cycles neither improves embryo implantation nor the pregnancy rates; therefore, further studies are required.

Graphene growth with no intended carbon precursor feeding into the LPCVD process: causes, solutions, and effects.

In this research, we have investigated the unintended graphene nucleation problem and its damaging effects on monolayer graphene synthesis in low-pressure chemical vapor deposition (LPCVD) process. This problem is the growth of graphene on the copper surface with no carbon feedstock. A new source of undesired carbon species was identified which has not been addressed so far. The hydrogen-rich heating stage was diagnosed as the onset of the unintended nucleation for the first time owing to the determinant catalytic role of hydrogen in this stage. It was found out that this problem leads to uncontrollable growth of multilayer graphene, growth of defective graphene film and also inhibition of the reliable synthesis of monolayer graphene. We managed to grow enhanced-quality monolayer graphene by developing some innovative solutions to the problem containing a general solution based on the hydrogen effects in the heating stage. The results reveal a significant decrease in the unintended nucleation density from ∼2000 to almost zero domains per 100 × 100 µm2 copper area. Furthermore, Raman, HRTEM and SAED analysis confirm the defect-free growth of monolayer graphene after employing the solutions. These findings could pave the way for the reliable synthesis of high-quality monolayer graphene as well as large-sized graphene domains.

Modeling the effect of static stretching and strengthening exercise in lengthened position on balance in low back pain subject with shortened hamstring: a randomized controlled clinical trial.

BACKGROUND: Hamstring shortening may have negative impacts on function and biomechanics of knee and hip joints and lumbo-pelvic rhythm. Many interventions are believed to correct hamstring to its normal length. There are several reports of impairment in postural control of patients with low back pain. The purpose of this study was to compare the effect of stretching exercise and strengthening exercise in lengthened position of the hamstring muscle on improving the dynamic balance of the person in patients with chronic low back pain with short hamstring muscles. METHODS: Forty-five patients with hamstring shortening who referred to physiotherapy clinic of Kermanshah university of Medical Sciences, Kermanshah, Iran were randomly allocated to the three groups; static stretching (n = 15), strengthening exercise in lengthened hamstring position (n = 15) and control (n = 15). All groups received conventional physiotherapy for low back pain and the two intervention groups received stretching exercise and strengthening exercise in lengthened position programs as well. All groups performed three treatment sessions for a week, a total of 12 sessions. For balance assessment, Y-Balance test was performed for each participant in three reach directions. To determine the important and significant variables, all variables entered a model (Generalized Estimation Equations method). RESULTS: The results indicate that based on GEE model, by controlling other variables, participants of static stretching exercise showed more improvement in balance than control group (ß = 9.58, p-value = 0.014). Also, balance status showed significant improvement in the end of study compared to baseline of the study (ß = 7.71, P-value< 0.001). In addition, the balance in three reach directions improved significantly and the greatest balance improvement was in the anterior reach direction (ß ranged over = 6.16 to 11.59) and the height of patients affected their balance (ß = 0.28, P-value = 0.034). CONCLUSIONS: Group (type of intervention), phase of intervention, reach direction of test (anterior, posteromedial and posterolateral) and height of participants were associated with balance performance. Static stretching exercise was more effective than muscle strengthening exercise in lengthened position for improving dynamic balance in low back pain patients with hamstring tightness. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (I RCT201507258035n2 ). Registered 16th September 2015.

A randomized clinical trial for the effect of static stretching and strengthening exercise on pelvic tilt angle in LBP patients.

BACKGROUND: Stretching and strengthening exercises are commonly used to improve muscle shortness of the hamstring as any tension in this muscle can have an effect on the pelvic posture. Thus, the aim of this study was to evaluate the effects of two methods of improving short hamstring on the angle of pelvic tilt in LBP sufferers. METHODS: Forty-five low back pain patients aged 19-59 years with hamstring tightness participated in this clinical trial. The patients were categorized randomly into three groups: 1- static stretching, 2-strengthening exercise and 3-control group. The two intervention groups received physical therapy and special exercise program thrice a week in a total of 12 sessions, while the control group received only conventional physical therapy. Before and after the treatment implementation, the pelvic tilt and straight leg raising (SLR) degree were assessed for each group. RESULT: After 12 sessions of treatment, the ANCOVA models indicated non-significant differences in pelvic tilt angle and SLR score changes (p > 0.05), among the three groups. In addition, no statistically significant correlation was observed between the pelvic tilt and SLR test [except for the strengthening exercise group (Pearson correlation coefficient = -0.54, P < 0.05)]. CONCLUSIONS: In LBP sufferers, both static stretching and strengthening of hamstring muscle in its lengthened position caused elongation and extensibility in the hamstring muscle and increased SLR test score, but did not change pelvic tilt angle.

Comparison of muscle activation imbalance following core stability or general exercises in nonspecific low back pain: a quasi-randomized controlled trial.

BACKGROUND: Low back pain causes changes in muscle activation patterns. Knowing how different exercises may improve altered muscle activation is useful in the treatment of patients. The aim of the study was to investigate whether there was a difference in the pattern of muscle activation in chronic nonspecific low back pain sufferers following core stability exercise (CSE) and general exercise (GE). METHODS: Fifty-six non-specific chronic LBP subjects were randomly assigned to either groups (28 participants in CSE and 28 in GE group). Both groups performed 16 sessions of an exercise program for about 5 weeks. Pain, disability and trunk muscle activation patterns (using surface electromyography) were measured at baseline and post-training. RESULTS: After the intervention period, antagonist coactivation ratio did not change in either groups. Though all compensated imbalance ratios (residual unequal muscular activity after cancellation of directionality) decreased towards negative (imbalance to left side) only this change for total muscles ratio in GE was significant (mean difference in GE group, 0.15; 95% CI: 0.02 to 0.28; p-value of paired t-test: 0.022); (mean difference in CSE, 0.02; 95% CI: - 0.07 to 0.11; p-value of paired t-test: 0.614).. No overall significantly decrease in uncompensated imbalance ratio (absolute imbalance values without cancellation directionality) was observed. Pain and disability decreased significantly in both groups. However, there was no difference between two groups in either of the variables after the intervention. CONCLUSIONS: Both exercise programs reduced pain and disability and made or kept trunk muscle activation imbalance to the left side. The effects of two exercises on pain, disability and antagonist coactivation or imbalance ratios were not different. TRIAL REGISTRATION: This study was registered in the Iranian Clinical Trial Center with the code IRCT201111098035N1, Registered Jan 21, 2013.