Investigating the relationship between pain level and grip and wrist muscles strength in individuals with lateral epicondylitis: is pain a barrier to strength assessment?

PURPOSE: This study was carried out to examine the relationship between rest, activity, and nighttime pain and grip and isokinetic muscle strength of the wrist muscles in individuals with lateral epicondylitis. METHODS: Fifty-six sedentary individuals aged between 18 and 65 years diagnosed with unilateral lateral epicondylitis volunteered to participate in the study. The level of rest, activity, and nighttime pain was evaluated with visual analog scale (VAS). The grip strengths of both arms were evaluated by averaging a maximum of three grip strength measurements using a hand dynamometer. The strength of both wrist flexor and extensor muscles were evaluated with isokinetic dynamometer at angular velocities of 60 and 180°/s with five and 15 concentric repetitions respectively. RESULTS: There was no significant relationship found between the affected side's grip strength and isokinetic muscle strength with rest, activity and nighttime pain (all P > 0.05). However, there was a difference observed between the affected and unaffected side in grip strength and isokinetic strength measurements of all wrist muscles (all P < 0.05); the unaffected side values were found to be higher. CONCLUSION: The result of this study found no correlation between the stated level of pain and the true muscle strength in the affected hand. In line with these findings, we think that assessments involving strength can be made in other musculoskeletal problems where pain is present. However, the findings may not reflect the true muscle strength which will tend to be underrated.

Effect of a calcium phosphate-containing desensitizing agent on postoperative sensitivity: A split-mouth, randomized controlled study.

PURPOSE: To evaluate the effectiveness of a calcium phosphate-containing-desensitizer (Teethmate Desensitizer - TD), caries type, subject age, and preoperative hypersensitivity on postoperative sensitivity (POS) after composite restorations on deep or extremely deep lesions. METHODS: 50 subjects, having two teeth with deep or extremely deep caries, participated in this study. TD was applied randomly to one tooth of each participant, and all teeth were restored with composite resin (Filtek Z250). After 1 week, POS was evaluated according to NRS (numerical rating scale) and VAS (visual analogue scale) by using participant diaries. At 6 weeks, POS was assessed considering subjects' reports. The normality of data was analyzed with Shapiro-Wilk test. For analyses, Pearson's chi-squared test, Mann-Whitney U and the Wilcoxon Signed-Rank test were used, and the effect sizes (ES) were calculated (α= 0.05). RESULTS: 47 of the participants completed the 6-week study. There was a small effect size noted for TD for NRS and VAS (P> 0.05, ES < 0.30). Also, there was no statistically significant difference between POS and subject age (P= 0.294, ES= 0.161), type of caries (P= 0.680, ES= 0.042) and preoperative sensitivity (P= 1.000, ES= 0.138) after the first week. CLINICAL SIGNIFICANCE: Teethmate Desensitizer had no significant effect on postoperative sensitivity occurrence with respect to caries type, subject age, and existence of preoperative sensitivity. The application of Teethmate Desensitizer demonstrated no significant relieving effect on postoperative sensitivity in deep or extremely deep cavities.

Effect of contraction type at varying angular velocities on isokinetic muscle strength training.

The aim of this study is to determine whether concentric and eccentric isokinetic training performed at certain angular velocities in sedentary individuals is effective only in the angular velocities and contraction type where the training is performed, or at other angular velocities and contraction types that are not being trained. Twenty-eight sedentary individuals (matched according to weight, age and gender) volunteered to participate in this case study. The study was conducted on a total of 56 extremities belonging to 28 individuals (14 women, 14 men) aged between 24 and 60 years. Concentric and eccentric strength tests were performed at 30-60-90-120-150-180°/sec. The participants were randomly divided into two groups as concentric training group and eccentric training group, through stratified randomization matching. The training was done 3 days a week for a total of 6 weeks. At the end of the study, no difference was found between the pre- and posttraining measurements in the concentric training group (P>0.05). In the eccentric training group, the eccentric muscle strength of the knee flexors and extensors at angular velocity of 90°/sec, the eccentric strength of the knee extensors at angular velocity of 120°/sec, and the eccentric muscle strength of the knee flexors at angular velocity of 180°/sec were found to be different and an increase was seen after the training (P=0.032, P=0.049, P=0.041, P=0.032). These results demonstrate that eccentric training may be preferred in cases where muscle strength increase is needed in short time.

Detection of grey zones in inter-rater agreement studies.

BACKGROUND: In inter-rater agreement studies, the assessment behaviour of raters can be influenced by their experience, training levels, the degree of willingness to take risks, and the availability of clear guidelines for the assessment. When the assessment behaviour of raters differentiates for some levels of an ordinal classification, a grey zone occurs between the corresponding adjacent cells to these levels around the main diagonal of the table. A grey zone introduces a negative bias to the estimate of the agreement level between the raters. In that sense, it is crucial to detect the existence of a grey zone in an agreement table. METHODS: In this study, a framework composed of a metric and the corresponding threshold is developed to identify grey zones in an agreement table. The symmetry model and Cohen's kappa are used to define the metric, and the threshold is based on a nonlinear regression model. A numerical study is conducted to assess the accuracy of the developed framework. Real data examples are provided to illustrate the use of the metric and the impact of identifying a grey zone. RESULTS: The sensitivity and specificity of the proposed framework are shown to be very high under moderate, substantial, and near-perfect agreement levels for [Formula: see text] and [Formula: see text] tables and sample sizes greater than or equal to 100 and 50, respectively. Real data examples demonstrate that when a grey zone is detected in the table, it is possible to report a notably higher level of agreement in the studies. CONCLUSIONS: The accuracy of the proposed framework is sufficiently high; hence, it provides practitioners with a precise way to detect the grey zones in agreement tables.

How reliable are the multiple comparison methods for odds ratio?

The homogeneity tests of odds ratios are used in clinical trials and epidemiological investigations as a preliminary step of meta-analysis. In recent studies, the severity or mortality of COVID-19 in relation to demographic characteristics, comorbidities, and other conditions has been popularly discussed by interpreting odds ratios and using meta-analysis. According to the homogeneity test results, a common odds ratio summarizes all of the odds ratios in a series of studies. If the aim is not to find a common odds ratio, but to find which of the sub-characteristics/groups is different from the others or is under risk, then the implementation of a multiple comparison procedure is required. In this article, the focus is placed on the accuracy and reliability of the homogeneity of odds ratio tests for multiple comparisons when the odds ratios are heterogeneous at the omnibus level. Three recently proposed multiple comparison tests and four homogeneity of odds ratios tests with six adjustment methods to control the type-I error rate are considered. The reliability and accuracy of the methods are discussed in relation to COVID-19 severity data associated with diabetes on a country-by-country basis, and a simulation study to assess the powers and type-I error rates of the tests is conducted.

The immediate effect of simulating leg-length discrepancy on spinal posture and pelvic position: a cross-over designed study.

Leg-length discrepancy (LLD) is a common condition that may cause posture changes and clinical consequences. Rasterstereography is a valid and reliable method that analyzes posture without radiation exposure and invasive procedures. This study aimed to assess the immediate effect of artificial LLD on pelvic position and spinal posture in athletes. Twenty-four elite karate athletes (14 men, 10 women) were included in the study. Sagittal imbalance, coronal imbalance, pelvic obliquity, pelvic torsion angle, thoracic kyphosis angle and lumbar lordosis angle were measured at different artificial LLD heights (5 -10 -15 -20 mm). Statistical analysis was performed with One-Way ANOVA with repeated measures or Friedman test. In cases where there were significant differences, pairwise comparisons were performed with least significant differences (LSD) test or Wilcoxon signed rank test. There were statistically significant differences in pelvic obliquity (p = 0.001), pelvic torsion (p = 0.001) and lumbar lordosis (p = 0.001) with varying LLD. However, there was no significant difference in sagittal imbalance, coronal imbalance and thoracic kyphosis angle. It has been observed that even a 5-mm LLD causes pelvic position and spinal posture changes. Future studies detecting these changes in populations with LLD via rastersterography may prevent possible musculoskeletal disorders.

The effects of resin infiltration on demineralized root surface: an experimental study.

Purpose: The objective of this experimental invitro study was to investigate the effects of resin infiltration (RI) on surface roughness, microhardness, color and surface characteristics of artificially demineralized root surfaces. Materials and methods: Forty-two root specimens prepared from freshly extracted intact human upper incisors were subjected to surface roughness, microhardness, and color tests. Profilometer was used to measure surface roughness and Vicker's Hardness tester was used to measure the changes in microhardness. The color measurements were performed by a spectrophotometer using the CIELAB parameters. Following measurements, specimens were divided into 3 groups (n=14): G1: intact root surfaces, G2: demineralized root surfaces and G3: Resin infiltrated root surfaces (Icon, DMG) following demineralization. Surface roughness, microhardness and color measurements were repeated in G2 and G3 after demineralization and RI. One specimen from each group was examined by SEM. Data were analyzed statistically (p<0.05). Results: Application of RI to artificially demineralized root surfaces significantly decreased the surface roughness (p<0.001) and increased the microhardness (p=0.023). RI also affected the color of demineralized root surfaces. SEM examinations revealed that the porosities on demineralized root surfaces seemed to be sealed after RI. Conclusion: RI affected the surface roughness, microhardness, color and surface appearance of artificially demineralized root surfaces.

Effects of charcoal-based whitening toothpastes on human enamel in terms of color, surface roughness, and microhardness: an in vitro study.

OBJECTIVE: Charcoal based oral care products have gained popularity in the last few years. The aim of this in vitro study was to compare the effects of different charcoal based whitening toothpastes on color, surface roughness and microhardness of human enamel. MATERIALS AND METHODS: Forty-eight specimens obtained from human permanent upper incisor teeth were randomly divided into 4 groups(n=12):Group-1:Colgate Total 12(CT); Group-2:Body Kingdom(BK); Group-3:Black is White(BW), Group-4:Colgate optic white(COW). Following 4 days cycle of darkening(2-min chlorhexidine and 60-min black tea per day), a 12- week brushing(twice daily for 1 min)was performed. Color of specimens was measured using a spectrophotometer. A contact type profilometer was used to measure surface roughness (Ra) and Vicker's hardness tester was used for the changes in microhardness(VHN). A representative sample from each group was visualized by SEM. Data were analyzed by One-way ANOVA, Welch, Fisher's, Kruskall-Wallis, Wilcoxon Sign Rank and Paired t-tests(p<0.05). RESULTS: After 12- week brushing, no differences were found among the groups in terms of color change(p=0.989). All toothpastes tested showed no clinically acceptable whitening performances. A substantial increase in surface roughness was found in all groups, except BW(p<0.05). An increase was found in microhardness with CT(p=0.013), while no changes were found with BK, BW and COW(p>0.05).Only few scratches were observed on the enamel surfaces by SEM evaluations. CONCLUSION: Twelve week brushing with charcoal based whitening toothpastes and a regular fluoridated toothpaste presented similar effects in color of enamel. Surface roughness was increased(except BW) while microhardness was not affected(except CT) with charcoal based whitening toothpastes. CLINICAL RELEVANCE: Charcoal based whitening toothpastes do not promise to whiten the human permanent teeth and their effects on enamel abrasion should not be disregarded.

Current Predictive Resting Metabolic Rate Equations Are Not Sufficient to Determine Proper Resting Energy Expenditure in Olympic Young Adult National Team Athletes.

Predictive resting metabolic rate (RMR) equations are widely used to determine athletes' resting energy expenditure (REE). However, it remains unclear whether these predictive RMR equations accurately predict REE in the athletic populations. The purpose of the study was to compare 12 prediction equations (Harris-Benedict, Mifflin, Schofield, Cunningham, Owen, Liu's, De Lorenzo) with measured RMR in Turkish national team athletes and sedentary controls. A total of 97 participants, 49 athletes (24 females, 25 males), and 48 sedentary (28 females, 20 males), were recruited from Turkey National Olympic Teams at the Ministry of Youth and Sports. RMR was measured using a Fitmate GS (Cosmed, Italy). The results of each 12 prediction formulas were compared with the measured RMR using paired t-test. The Bland-Altman plot was performed to determine the mean bias and limits of agreement between measured and predicted RMRs. Stratification according to sex, the measured RMR was greater in athletes compared to controls. The closest equation to the RMR measured by Fitmate GS was the Harris-Benedict equation in male athletes (mean difference -8.9 (SD 257.5) kcal/day), and Liu's equation [mean difference -16.7 (SD 195.0) kcal/day] in female athletes. However, the intra-class coefficient (ICC) results indicated that all equations, including Harris-Benedict for male athletes (ICC = 0.524) and Liu's for female athletes (ICC = 0.575), had a moderate reliability compared to the measured RMR. In sedentary subjects, the closest equation to the measured RMR is the Nelson equation in males, with the lowest RMSE value of 118 kcal/day [mean difference: 10.1 (SD 117.2) kJ/day], whereas, in females, all equations differ significantly from the measured RMR. While Nelson (ICC = 0.790) had good and Owen (ICC = 0.722) and Mifflin (calculated using fat-free mass) (ICC = 0.700) had moderate reliability in males, all predictive equations showed poor reliability in females. The results indicate that the predictive RMR equations failed to accurately predict RMR levels in the participants. Therefore, it may not suitable to use them in determining total energy expenditure.

Thrombophilic polymorphisms are not associated with disease-free survival in breast cancer patients.

BACKGROUND: Thrombosis is one of the most common complications in cancer patients, however the effect of thrombophilic polymorphisms on cancer specific survival is still unclear. OBJECTIVES: The aims of the study were to analyze the effect of factor V Leiden (FVL), prothrombin (PT) G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms on disease-free survival (DFS) in breast cancer and to evaluate the proportional odds model. METHODS: Relationship between thrombophilic polymorphisms and DFS was evaluated in 197 breast cancer patients. Data regarding patient's age, menopausal status, tumor size (T), lymph node status (N), cancer stage, tumor grade (G), estrogen and progesterone receptors, c-erbB2 expression, MTHFRC677T, FVL, and PTG20210A polymorphisms in DFS were examined by log-rank test and multivariate analyses. The proportional odds model was tested as an alternative to Cox model because of its insufficient proportional hazards assumption. RESULTS: According to log-rank test, T, N, G, tumor stage, and c-erbB2 were associated with DFS. T, N, G, and c-erbB2 were significantly related to DFS by log-normal regression model. PTG20210A, MTHFRC677T and FVL polymorphisms were not related to DFS in breast cancer (P>0.05). CONCLUSION: Our study suggests that thrombophilic polymorphisms are not associated with DFS when the proportional odds model is applied.