Additional effect of neuromuscular electrical stimulation in a conservative intervention on morphology and strength of abductor hallucis muscle and correction of hallux valgus deformity: a randomized controlled trial.

BACKGROUND: In hallux valgus, morphological changes and functional weakness of intrinsic foot muscles occur, especially in the abductor hallucis muscle. OBJECTIVES: This study aimed to investigate how a conservative treatment with the addition of neuromuscular electrical stimulation affects the volume and strength of the muscle, the correction of deformity, passive range of motion, pain, and disability. METHODS: Twenty-eight female participants (48 feet) were randomly assigned to two groups. The interventions included orthoses and exercise (Ortho) in both groups. One group received additional neuromuscular electrical stimulation of abductor hallucis muscle to activate it. Each group received the treatments for one month and was assessed two times, at baseline before starting and after one month of treatment. Mixed within-between ANOVA, analysis of covariance, and nonparametric tests were used for data analysis. RESULTS: The muscle volume, abduction strength, goniometric angle, and passive hallux dorsi/plantar flexion showed significant changes in both groups (p < .001). Subscales of the foot and ankle ability questionnaire, significantly changed (p ≤ .05). Pain decreased significantly in the two groups (p < .001 and p = .02). Intermetatarsal angle did not significantly differ between the two groups (p = .86, partial eta effect size = 0.001). But, the hallux valgus angle mean (on MRI) in the Ortho group was less than that of the orthoNMES group (p = .007, partial eta effect size = 0.15). CONCLUSION: Both groups showed nearly identical treatment effects in the primary volume and hallux valgus correction outcome measures. In this study, adding neuromuscular electrical stimulation did not have an additional effect compared to conservative in the treatment of hallux valgus. TRIAL REGISTRATION NUMBER: The RCT Code is IRCT20200915048725N1.

The effects of a custom foot orthosis on dynamic plantar pressure in patients with chronic plantar fasciitis: A randomized controlled trial.

BACKGROUND: Plantar fasciitis is one of the most common causes of heel pain. The plantar fascia supports the longitudinal arch and absorbs ground reaction forces during the static and dynamic phase(s) of weight-bearing. The purpose of this randomized controlled trial study was to determine the effects of CAD/CAM foot orthoses that were designed based on the dynamic plantar pressure in patients with plantar fasciitis. METHODS: This study was performed on 34 patients with plantar fasciitis. Outcomes were compared based on plantar fascia thickness; peak pressure, mean pressure, and maximum force; and pain, activity of daily living, quality of life, and sports activity that were evaluated by ultrasound, plantar pressure platform, and the Foot and Ankle Outcome Score, respectively. The patients were randomly assigned into two groups: the experimental group (CAD/CAM orthoses and night splint) and the control group (night splint only). All data were recorded again after 4 weeks. RESULTS: Pain ( P = 0.002) and plantar fascia thickness ( P = 0.001) decreased significantly after 1 month of intervention. Activity of daily living ( P = 0.044) and quality of life ( P = 0.001) showed a significant increase. There was a trend in increasing peak pressure in all masking regions in both groups. The maximum force remarkably reduced in the experimental group in all regions. CONCLUSIONS: The results demonstrated that CAD/CAM foot orthoses designed based on dynamic plantar pressure with night splint can reduce the plantar fascia thickness and pain associated with plantar fasciitis and increase the activity of daily living, quality of life, and sports activity.

A Multicenter Survey on the Trend of Chest CT Scan Utilization: Tracing the First Footsteps of COVID-19 in Iran.

BACKGROUND: Chest computed tomography (CT) scan has been used widely to diagnose COVID-19 in Iran. OBJECTIVES: To trace the footsteps of COVID-19 in Iran by exploring the trend in using chest CT scans and its economic impact on radiology departments. Methods: In this cross-sectional study, the number of imaging examinations from 33 tertiary radiology departments in 9 large cities of Iran was collected from September 23, 2019 to March 20, 2020 (Months 1 to 6) and the corresponding months in 2018-2019. RESULTS: A 50.2% increase was noted in the chest CT scan utilization in 2019-2020 compared to 2018-2019. This increase was +15%, +15%, +27%, +2%, +1% in Months 1-5 of 2019-2020, respectively. In Month 6 of 2019-2020, a 251% increase in the acquisition of chest CT scans was observed compared to the Month 6 of 2018-2019. Following negative balance of revenue from Month 1 to 5 with respect to the inflation rate, the total income in Month 6 was further 1.5% less than the same Month in 2018-19. CONCLUSION: The observed peak in chest CT utilization in Month 3 prior to the surge in Month 6 could be explained by the seasonal influenza. However, unawareness about an emerging viral disease, i.e. COVID-19, might have underutilized chest CT in Months 4 and 5 before the official announcement in Month 6. The unbalanced increase in the workload of radiology departments in the shortage of cardiothoracic radiologists with the simultaneous decrease in income initiated a vicious cycle that worsened the economic repercussions of the pandemic.

Automatic detection of symmetry plane for computer-aided surgical simulation in craniomaxillofacial surgery.

Symmetry plane calculation is used in fracture reduction or reconstruction in the midface. Estimating a reliable symmetry plane without advanced anatomic knowledge is the most critical challenge. In this work, we developed a new automated method to find the mid-plane in CT images of an intact skull and a skull with a unilateral midface fracture. By use of a 3D point-cloud of a skull, we demonstrate that the proposed algorithm could find a mid-plane that meets clinical criteria. There is no need for advanced anatomical knowledge through the use of this algorithm. The algorithm used principal component analysis to find the initial plane. Then the rotation matrix, derived from an iterative closest point (ICP) registration method, is used to update the normal vector of the plane and find the optimum symmetry plane. A mathematical index, Hausdorff distance (HD), is used to evaluate the similarity of one mid-plane side in comparison to the contralateral side. HD decreased by 66% in the intact skull and 65% in a fractured skull and converged in just six iterations. High convergence speed, low computational load, and high accuracy suggest the use of the algorithm in the planning procedure. This easy-to-use algorithm with its advantages, as mentioned above, could be used as an operator in craniomaxillofacial software.

Classification algorithms with multi-modal data fusion could accurately distinguish neuromyelitis optica from multiple sclerosis.

Neuromyelitis optica (NMO) exhibits substantial similarities to multiple sclerosis (MS) in clinical manifestations and imaging results and has long been considered a variant of MS. With the advent of a specific biomarker in NMO, known as anti-aquaporin 4, this assumption has changed; however, the differential diagnosis remains challenging and it is still not clear whether a combination of neuroimaging and clinical data could be used to aid clinical decision-making. Computer-aided diagnosis is a rapidly evolving process that holds great promise to facilitate objective differential diagnoses of disorders that show similar presentations. In this study, we aimed to use a powerful method for multi-modal data fusion, known as a multi-kernel learning and performed automatic diagnosis of subjects. We included 30 patients with NMO, 25 patients with MS and 35 healthy volunteers and performed multi-modal imaging with T1-weighted high resolution scans, diffusion tensor imaging (DTI) and resting-state functional MRI (fMRI). In addition, subjects underwent clinical examinations and cognitive assessments. We included 18 a priori predictors from neuroimaging, clinical and cognitive measures in the initial model. We used 10-fold cross-validation to learn the importance of each modality, train and finally test the model performance. The mean accuracy in differentiating between MS and NMO was 88%, where visible white matter lesion load, normal appearing white matter (DTI) and functional connectivity had the most important contributions to the final classification. In a multi-class classification problem we distinguished between all of 3 groups (MS, NMO and healthy controls) with an average accuracy of 84%. In this classification, visible white matter lesion load, functional connectivity, and cognitive scores were the 3 most important modalities. Our work provides preliminary evidence that computational tools can be used to help make an objective differential diagnosis of NMO and MS.

Dynamic comparison of segmentary scapulohumeral rhythm between athletes with and without impingement syndrome.

BACKGROUND: Patients who have shoulder pain usually have compensatory or contributory deviation of shoulder motion during arm elevation. In the traditional scapulohumeral rhythm, the share of the acromioclavicular (AC) and the sternoclavicular (SC) joint movements and also the role of AC internal rotation angle are unknown. OBJECTIVES: The main purpose of this study was to measure and compare the segmentary scapulohumeral rhythm (SSHR) during scapular arm elevation at a steady rotational speed in athletes with and without impingement syndrome. PATIENTS AND METHODS: Using a speedometer, the maximum speed of arm elevation was measured in 21 men in each of the involved and uninvolved groups. Using fluoroscopy on the dominant side, SSHR during scapular arm elevation at a rotational speed equal to 1/30 of maximum speed was compared between the two groups. The ratio of glenohumeral (GH) elevation angle to AC rotation angle in the scapular plane was considered as SSHR. RESULTS: The maximum speed of arm elevation between the two groups was significantly different (P < 0.001). The rhythm of the involved group significantly exceeded the rhythm of the uninvolved group in a part of the first quarter range of the arm elevation. SSHR during arm elevation in the uninvolved group did not change significantly (P = 0.845); however, it decreased significantly in the involved group (P = 0.024). CONCLUSIONS: Speed differences between the two groups were probably due to the pain in some ranges of arm elevation. SSHR in the involved group probably changed in order to compensate downward rotation of the scapula in the resting position. Study of the AC upward rotation range can be misleading; therefore, the study of scapulohumeral rhythm is recommended.

Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: a systematic review.

Plantar fasciitis (PFS) is one of the most common causes of heel pain, estimated to affect 10% of the general population during their lifetime. Ultrasound (US) imaging technique is increasingly being used to assess plantar fascia (PF) thickness, monitor the effect of different interventions and guide therapeutic interventions in patients with PFS. The purpose of the present study was to systematically review previously published studies concerning the application of US in the assessment of PF in patients with PFS. A literature search was performed for the period 2000-2012 using the Science Direct, Scopus, PubMed, CINAHL, Medline, Embase and Springer databases. The key words used were: ultrasound, sonography, imaging techniques, ultrasonography, interventional ultrasonography, plantar fascia and plantar fasciitis. The literature search yielded 34 relevant studies. Sixteen studies evaluated the effect of different interventions on PF thickness in patients with PFS using US; 12 studies compared PF thickness between patients with and without PFS using US; 6 studies investigated the application of US as a guide for therapeutic intervention in patients with PFS. There were variations among studies in terms of methodology used. The results indicated that US can be considered a reliable imaging technique for assessing PF thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with PFS.

Rehabilitation after ACL injury: a fluoroscopic study on the effects of type of exercise on the knee sagittal plane arthrokinematics.

A safe rehabilitation exercise for anterior cruciate ligament (ACL) injuries needs to be compatible with the normal knee arthrokinematics to avoid abnormal loading on the joint structures. The objective of this study was to measure the amount of the anterior tibial translation (ATT) of the ACL-deficient knees during selective open and closed kinetic chain exercises. The intact and injured knees of fourteen male subjects with unilateral ACL injury were imaged using uniplanar fluoroscopy, while the subjects performed forward lunge and unloaded/loaded open kinetic knee extension exercises. The ATTs were measured from fluoroscopic images, as the distance between the tibial and femoral reference points, at seven knee flexion angles, from 0° to 90°. No significant differences were found between the ATTs of the ACL-deficient and intact knees at all flexion angles during forward lunge and unloaded open kinetic knee extension (P < 0.05). During loaded open kinetic knee extension, however, the ATTs of the ACL deficient knees were significantly larger than those of the intact knees at 0° (P = 0.002) and 15° (P = 0.012). It was suggested that the forward lunge, as a weight-bearing closed kinetic chain exercise, provides a safer approach for developing muscle strength and functional stability in rehabilitation program of ACL-deficient knees, in comparison with open kinetic knee extension exercise.

Comparison of kinematics of ACL-deficient and healthy knees during passive flexion and isometric leg press.

BACKGROUND: Studying the kinematics of the ACL deficient (ACLD) knees, during different physiological activities and muscle contraction patterns, can improve our understanding of the joint's altered biomechanics due to ACL deficiency as well as the efficacy and safety of the rehabilitations exercises. METHODS: Twenty-five male volunteers, including 11 normal and 14 unilateral ACLD subjects, participated in this study. The kinematics of the injured knees of the ACLD subjects was compared with their intact knees and the healthy group during passive flexion and isometric leg press with the knees flexed from full extension to 45° flexion, with 15° intervals. An accurate registration algorithm was used to obtain the three dimensional kinematical parameters, from magnetic resonance images. RESULTS: The ACL deficiency mainly altered the tibial anterior translation, and to some extent its internal rotation, with the change in other parameters not significant. During leg press, the anterior translation of the ACLD knees was significantly larger than that of the normal knees at 30° flexion, but not at 45°. Comparison of the anterior translations of the ACLD knees during leg press with that of the passive flexion revealed improved consistency (CVs changed from 1.2 and 4.0 to 0.6 and 0.6, at 30° and 45° flexion, respectively), but considerable larger translations (means increased by 6.2 and 4.9mm, at 30° and 45° flexion, respectively). CONCLUSION: The simultaneous contraction of the quadriceps and hamstrings during leg press, although reduces the knee laxity, cannot compensate for the loss of the ACL to restore the normal kinematics of the joint, at least during early flexion.

Assessment of the effect of radio contrast media on resistive index of renal artery by color doppler sonography.

Renal ischemia and direct toxic effect of contrast media are the main confounding causes of contrast-induced nephropathy (CIN). The effect of different contrast mediums on the resistance of renal artery is quite unclear. The aim of the present study was to assess the resistive index (RI) changes of renal segmental artery in color Doppler duplex sonography after injection of two different contrast mediums: iodixanol and iohexol. The RI of the renal segmental artery of 62 randomly chosen patients, with a normal baseline renal function, was calculated using color-coded Doppler sonography before and five minutes after bolus injection of two different contrast mediums. Thirty-one patients were administered 50 mL of iodixanol (Visipaque) and 31 patients were administered 50 mL of iohexol (Omnipaque) during intravenous urogram procedures. The RI results were analyzed and compared in two groups using two-tailed t-test. The mean RI of renal segmental artery increased significantly after administration of contrast media (mean +/- SD 0.61 +/- 0.046 vs 0.58 +/- 0.042; p< 0.001). The mean change of RI was 0.0387 +/- .00552 (mean +/- SE) in the setting of iohexol injection and 0.0216 +/- .00423 (mean +/- SE) five minutes after administration of iodixanol (p= 0.017). Both non-ionic iso-osmolar dimeric iodixanol and low-osmolar iohexol increase the renal artery resistance, but the changes are more dramatic with iohexol, suggesting better tolerance with iodixanol.