Clinical evaluation of post-surgical scar hyperaesthesia: a longitudinal observational pilot study.

Introduction: The mechanisms underlying persistent scar pain are not fully elucidated and evidence for the clinical evaluation of scar pain is limited. This pilot observational study investigated participation data and sought to identify objective clinical scar evaluation measures for future trials. Methods: With ethical approval and consent, adults undergoing planned hand surgery were enrolled from one NHS hospital. At 1- and 4-months post-surgery scar thermal and mechanical pain thresholds were evaluated with quantitative sensory testing; peri-scar inflammation with infrared thermometry and pliability with durometry. Participation data were analysed with descriptive statistics; the association of clinical measures with patient reported scar pain was analysed. Results: Twenty-one participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No adverse events or dropouts resulted from clinical scar evaluation. Seventy percent of participants reported undertaking topical, nonprescription scar treatment independently. Neuropathic Pain Symptom Inventory (NPSI) scores were dispersed across the score range, capturing variability in participant-reported scar symptoms. Scar morphology, pliability and inflammation were not associated with scar pain. Differences between scar and contralateral skin in thermal and mechanical pain sensitivity were identified. Conclusion: People with acute hand scars participate in clinical research and independently initiate scar treatment. Clinical testing of acute post-surgical hand scars is well tolerated. The NPSI demonstrates utility for exploring scar pain symptoms and may support the elucidation of mechanisms of persistent scar pain. Clinical tests of thermal and mechanical and sensitivity are promising candidate clinical measures of scar pain for future trials. Lay Summary: Background: it is unknown why some scars remain painful long-term. We do not know if scar flexibility, inflammation or sensitivity to temperature or pressure relate to scar pain. We investigated if patients would enrol in scar research, if scar testing was tolerated and if clinical tests are useful for future scar studies. Study conduct: with ethical approval and consent, adult hand surgery patients were enrolled from one NHS hospital. Scar pain, inflammation and response to thermal, sharp and pressure tests were assessed at 1- and 4-months after surgery. Statistically, we analysed study participation, tolerance for clinical scar tests and if the scar tests related to scar pain. Findings: 21 participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No participants were injured due to scar testing. 70% of participants reported treating their scar independently. Neuropathic Pain Symptom Inventory (NPSI) allows participants to give a broad range of answers about their scar symptoms. Scores for clinical tests of scar flexibility and inflammation did not relate to participant-reported scar pain. Scars were more sensitive to tests of pin prick and cold than unaffected skin. What we learned: people with new hand scars participate in research and independently initiate scar treatment. Clinical testing of post-surgical hand scars is well tolerated. The NPSI is useful for exploring scar pain symptoms and may help us to learn about persistent scar pain. Pinprick and cold clinical tests may be useful objective pain tests for future scar research.

Intra and interrater reliability for lower limb flexibility assessment using photogrammetry.

INTRODUCTION: Photogrammetry represents an advancement in the flexibility evaluation, and although it was highly explored for postural assessment, there is a scarcity of studies analyzing lower limb angular measurements using it. The purpose of this study is to verify the reliability of intrarater and interrarater photogrammetry in assessing lower limb flexibility. METHODS: This was a randomized cross-sectional observational study with test-retest design and a two-day interval. Thirty healthy, physically active adults were included. Three novice raters assessed the participants through flexibility tests of iliopsoas, hamstring, quadriceps and gastrocnemius on two occasions, and independently analyzed the captured images to establish reliability. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. RESULTS: Intrarater reliability was excellent for iliopsoas (ICC = 0.96; SEM = 1.4; MDC = 3.8), hamstring (ICC = 0.99; SEM = 1.1; MDC = 3.1), quadriceps (ICC = 0.99; SEM = 0.8; MDC = 2.3) and gastrocnemius (ICC = 0.98; SEM = 0.9; MDC = 2.5). Interrater reliability was excellent for iliopsoas (ICC = 0.94; SEM = 1.7; MDC = 4.6) and gastrocnemius (ICC = 0.91; SEM = 2.1; MDC = 5.8), but good for hamstring (ICC = 0.90; SEM = 2.8; MDC = 7.9) and quadriceps (ICC = 0.85; SEM = 3.0; MDC = 8.3). CONCLUSIONS: The excellent intrarater and good to excellent interrater reliability suggest that photogrammetry assessment of lower limb flexibility by novice raters is reliable. However, clinicians should consider the higher threshold of range of motion change necessary to outweigh measurement error due to interrater variability.

Impaired flexibility in patients with tropical spastic paraparesis/HTLV-associated myelopathy: evaluation via pendulum fleximeter / Flexibilidade prejudicada em pacientes com paraparesia espástica tropical/mielopatia associada ao HTLV: avaliação via flexímetro pendular

Abstract Background Flexibility is crucial to the harmonious execution of joint movements. While skeletal muscle dysfunction in patients with HTLV-1 can interfere with mobility, it is unclear whether these patients experience reduced flexibility. Objective To evaluate the differences in flexibility between HTLV-1-infected individuals with and without myelopathy compared with uninfected controls. We also investigated whether age, sex, body mass index (BMI), physical activity level, or lower back pain influence flexibility in HTLV-1-infected individuals. Methods The sample consisted of 56 adults, of which 15 did not have HTLV-1, 15 had HTLV-1 without myelopathy, and 26 had TSP/HAM. Their flexibility was assessed using the sit-and-reach test and a pendulum fleximeter. Results No differences in flexibility were observed between the groups with and without myelopathy and controls without HTLV-1 infection using the sit-and-reach test. The pendulum fleximeter results of individuals with TSP/HAM presented the lowest flexibility among the groups with respect to trunk flexion, hip flexion and extension, knee flexion, and ankle dorsiflexion, even after adjusting for age, sex, BMI, level of physical activity, and lower back pain using multiple linear regression models. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced flexibility in movements: knee flexion, dorsiflexion, and ankle plantar flexion. Conclusions Individuals with TSP/HAM demonstrated reduced flexibility in most of the movements evaluated by the pendulum fleximeter. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced knee and ankle flexibility, potentially representing a marker of myelopathic development.

Resumo Antecedentes A flexibilidade é fundamental para a execução harmoniosa dos movimentos articulares. Embora a disfunção do músculo esquelético em pacientes com HTLV-1 possa interferir na mobilidade, não está claro se esses pacientes apresentam flexibilidade reduzida. Objetivo Avaliar as diferenças de flexibilidade entre os indivíduos infectados com e sem mielopatia e o grupo controle sem infecção HTLV-1. Também investigamos se idade, sexo, índice de massa corporal (IMC), nível de atividade física ou dor lombar influenciam a flexibilidade em indivíduos infectados pelo HTLV-1. Métodos A amostra foi composta por 56 adultos, dos quais 15 não possuíam HTLV-1, 15 possuíam HTLV-1 sem mielopatia e 26 possuíam TSP/HAM. A flexibilidade foi avaliada por meio do teste de sentar e alcançar e do flexímetro de pêndulo. Resultados Não foram observadas diferenças na flexibilidade entre os grupos com e sem mielopatia no teste de sentar e alcançar. Os resultados do flexímetro pendular dos indivíduos com TSP/HAM apresentaram a menor flexibilidade entre os grupos em relação à flexão do tronco, flexão e extensão do quadril, flexão do joelho e dorsiflexão do tornozelo, mesmo após ajuste para idade, sexo, IMC, nível de atividade física e dor lombar usando modelos de regressão múltipla linear. Além disso, os indivíduos infectados pelo HTLV-1 sem mielopatia demonstraram redução da flexibilidade nos movimentos de flexão do joelho, dorsiflexão e flexão plantar do tornozelo. Conclusão Indivíduos com TSP/HAM demonstraram redução da flexibilidade na maioria dos movimentos avaliados pelo flexímetro pendular. Além disso, indivíduos infectados pelo HTLV-1 sem mielopatia demonstraram redução da flexibilidade do joelho e tornozelo, representando potencialmente um marcador de desenvolvimento mielopático.

Flexibility training improves elegance in ice ballet / Treinamento de flexibilidade melhora a elegância do balé no gelo / El entrenamiento de la flexibilidad mejora la elegancia en el ballet sobre hielo

ABSTRACT Introduction Ice ballet is performed through various movements with high artistic attributes such as skating, foot movement, rotation, and jumping on ice. The development of ice ballet flexibility can make the movements more graceful and coordinated and improve muscle strength. The athlete's flexibility can prevent accidents and reduce injuries. Objective This study aimed to analyze the effect of body flexibility on improving movement skills in ice ballet. Methods This paper selects ten ice ballet athletes as the object of research. The physiological and biochemical indicators of the athletes are examined by employing literature, experience, and data statistics. An investigation of the effect of physical flexibility on the performance of ice sports is carried out. Results The athletes exhibited high flexibility, and their muscles, tendons, and ligaments evidenced improved elasticity and extensibility. There is a correlation between body fat and flexibility in the athletes. The athletes exhibited no metric difference in body composition after the competition. Conclusion Flexibility training is significant in improving the movement abilities of athletes. Focusing on flexibility training in athletes' daily training allows them to improve the flexibility and extensibility of their muscles, tendons, and ligaments. There is a correlation between body fat and flexibility in athletes. The athletes had approximately the same body composition metrics after the competition. Focusing on flexibility training during athletes' daily training allows for improved flexibility in sports movements. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução O balé no gelo é realizado através de vários movimentos com altos atributos artísticos como patinação, movimento de pés, rotação e pulo no gelo. O desenvolvimento da flexibilidade do balé no gelo pode tornar os movimentos mais graciosos e coordenados e melhorar a força muscular. A flexibilidade do atleta pode prevenir acidentes e reduzir lesões. Objetivo Este estudo teve como objetivo analisar o efeito da flexibilidade corporal na melhoria das habilidades de movimento do balé no gelo. Métodos Este trabalho seleciona dez atletas de balé no gelo como o objeto de pesquisa. São examinados os indicadores fisiológicos e bioquímicos dos atletas empregando literatura, experiência e estatísticas de dados. É feita uma investigação sobre o efeito da flexibilidade física sobre o desempenho dos esportes no gelo. Resultados Os atletas exibiram alta flexibilidade, e seus músculos, tendões e ligamentos evidenciaram melhor elasticidade e extensibilidade. Há uma correlação entre a gordura corporal e a flexibilidade nos atletas. Os atletas não exibiram diferença métrica na composição corporal após a competição. Conclusão O treinamento de flexibilidade é significativo para melhorar as habilidades de movimento dos atletas. A concentração no treinamento de flexibilidade no treinamento diário dos atletas permite melhorar a flexibilidade e a extensibilidade de seus músculos, tendões e ligamentos. Há uma correlação entre a gordura corporal e a flexibilidade nos atletas. Os atletas tinham aproximadamente a mesma métrica de composição corporal após a competição. A concentração no treinamento de flexibilidade durante o treinamento diário dos atletas permite melhorar a flexibilidade dos movimentos esportivos. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción El ballet sobre hielo se realiza a través de varios movimientos con altos atributos artísticos como el patinaje, el movimiento de los pies, la rotación y los saltos sobre el hielo. El desarrollo de la flexibilidad del ballet sobre hielo puede hacer que los movimientos sean más gráciles y coordinados y mejorar la fuerza muscular. La flexibilidad del deportista puede evitar accidentes y reducir las lesiones. Objetivo Este estudio tenía como objetivo analizar el efecto de la flexibilidad corporal en la mejora de las habilidades de movimiento del ballet sobre hielo. Métodos Este trabajo selecciona como objeto de investigación a diez atletas de ballet sobre hielo. Los indicadores fisiológicos y bioquímicos de los atletas se examinan empleando la literatura, la experiencia y los datos estadísticos. Se lleva a cabo una investigación sobre el efecto de la flexibilidad física en el rendimiento de los deportes sobre hielo. Resultados Los atletas mostraron una gran flexibilidad, y sus músculos, tendones y ligamentos evidenciaron una mayor elasticidad y extensibilidad. Existe una correlación entre la grasa corporal y la flexibilidad en los deportistas. Los atletas no mostraron diferencias métricas en la composición corporal después de la competición. Conclusión El entrenamiento de la flexibilidad es importante para mejorar las habilidades de movimiento de los atletas. Centrarse en el entrenamiento de la flexibilidad en el entrenamiento diario de los deportistas les permite mejorar la flexibilidad y la extensibilidad de sus músculos, tendones y ligamentos. Existe una correlación entre la grasa corporal y la flexibilidad en los deportistas. Los atletas tenían aproximadamente las mismas métricas de composición corporal después de la competición. Centrarse en el entrenamiento de la flexibilidad durante el entrenamiento diario de los deportistas permite mejorar la flexibilidad en los movimientos deportivos. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Stromal vascular fraction-enriched fat grafting as treatment of adherent scars: study design of a non-randomized early phase trial.

BACKGROUND: In the last decades, autologous fat grafting has been used to treat adherent dermal scars. The observed regenerative and scar-reducing properties have been mainly ascribed to the tissue-derived stromal vascular fraction (tSVF) in adipose tissue. Adipose tissue's components augment local angiogenesis and mitosis in resident tissue cells. Moreover, it promotes collagen remodeling. We hypothesize that tSVF potentiates fat grafting-based treatment of adherent scars. Therefore, this study aims to investigate the effect of tSVF-enriched fat grafting on scar pliability over a 12-month period. METHODS AND DESIGN: A clinical multicenter non-randomized early phase trial will be conducted in two dedicated Dutch Burn Centers (Red Cross Hospital, Beverwijk, and Martini Hospital, Groningen). After informed consent, 46 patients (≥18 years) with adherent scars caused by burns, necrotic fasciitis, or degloving injury who have an indication for fat grafting will receive a sub-cicatricic tSVF-enriched fat graft. The primary outcome is the change in scar pliability measured by the Cutometer between pre- and 12 months post-grafting. Secondary outcomes are scar pliability (after 3 months), scar erythema, and melanin measured by the DSM II Colormeter; scar quality assessed by the patient and observer scales of the Patient and Observer Scar Assessment Scale (POSAS) 2.0; and histological analysis of scar biopsies (voluntary) and tSVF quality and composition. This study has been approved by the Dutch Central Committee for Clinical Research (CCMO), NL72094.000.20. CONCLUSION: This study will test the clinical efficacy of tSVF-enriched fat grafting to treat dermal scars while the underlying working mechanism will be probed into too. TRIAL REGISTRATION: Dutch Trial Register NL 8461. Registered on 16 March 2020.

Towards the Development of a Device for Assessing the Pliability of Burn Scars.

Burn injuries requires post-accident medical treatment. However, the treatment of burns does not end with first aid because scarred skin must be managed for many years, and in some circumstances, for life. The methods used to evaluate the state of a burn scar based, for instance, on Patient and Observer Scar Assessment Scale or similar ones, often lacks in univocally assessing the scarred skin's state of health. As a result, the primary aim of this research is to design and build a prototype that can support the doctor during scar assessment, and eventually therapy, by providing objective information on the state of the lesion, particularly the value of skin pliability. The developed tool is based on the depressomassage treatment probe named LPG, currently used to treat burn scars in a number of hospitals. It consists of a non-invasive massage technique using a mechanical device to suction and mobilize scar tissue and is used as a post-operative treatment to speed up the healing process to make the mark of the scar less visible. The prototype is specifically designed to be manufactured using Additive Manufacturing and was validated comparing its performances against the ones of a certified instrument (i.e., the Romer Absolute ARM with RS1 probe). Validation was carried out by designing and developing a tool to put the RS1 probe in the same measurement conditions of the new prototype probe. Tests performed to assess the performance of the devised prototype show that the probe developed in this work is able to provide measurements with a sufficient degree of accuracy (maximum error ±0.1 mm) to be adopted for a reliable estimation of the pliability value in a hospital environment.

Hemicellulose and Nano/Microfibrils Improving the Pliability and Hydrophobic Properties of Cellulose Film by Interstitial Filling and Forming Micro/Nanostructure.

In this paper, nano/microfibrils were applied to enhance the mechanical and hydrophobic properties of the sugarcane bagasse fiber films. The successful preparation of nano/microfibrils was confirmed by scanning electron microscope (SEM), X-ray diffraction (XRD), fiber length analyzer (FLA), and ion chromatography (IC). The transparency, morphology, mechanical and hydrophobic properties of the cellulose films were evaluated. The results show that the nanoparticle was formed by the hemicellulose diffusing on the surface of the cellulose and agglomerating in the film-forming process at 40 °C. The elastic modulus of the cellulose film was as high as 4140.60 MPa, and the water contact angle was increased to 113°. The micro/nanostructures were formed due to hemicellulose adsorption on nano/microfilament surfaces. The hydrophobicity of the films was improved. The directional crystallization of nano/microfibrous molecules was found. Cellulose films with a high elastic modulus and high elasticity were obtained. It provides theoretical support for the preparation of high-performance cellulose film.

A one-time pneumatic jet-injection of 5-fluorouracil and triamcinolone acetonide for treatment of hypertrophic scars-A blinded randomized controlled trial.

BACKGROUND: Patients with hypertrophic scars (HTS) risk reduced quality of life due to itching, pain, poor cosmesis, and restriction of movement. Despite good clinical efficacy, patients are often reluctant to undergo repeated needle injections due to pain or needle phobia. OBJECTIVES: To evaluate the applicability of needle-free pneumatic jet injection (PJI) and assess changes in hypertrophic scars following a single PJI treatment with 5-fluorouracil (5-FU) and triamcinolone acetonide (TAC). METHODS: Twenty patients completed this blinded, randomized, controlled, split-scar trial. The intervention side of the HTS received a one-time treatment with PJIs containing a mixture of TAC + 5-FU injected at 5 mm intervals (mean 7 PJI per HTS); the control side received no treatment. Assessments were made at baseline and 4 weeks posttreatment. Outcome measures included change in (1) Vancouver Scar Scale (VSS) total score and subscores, (2) scar volume and surface area assessed by three-dimensional imaging, (3) skin microarchitecture measured by optical-coherence tomography (OCT), (4) photo-assessed scar cosmesis (0-100), (5) patient-reported pain and satisfaction (0-10), and (6) depiction of drug biodistribution after PJI. RESULTS: PJI with TAC + 5-FU significantly decreased both HTS height (-1 VSS; p = 0.01) and pliability (-1 VSS; p < 0.01) with a nonstatistically significant reduction of -1 in total VSS score (0 in control; p = 0.09). On 3D imaging, a 33% decrease in scar volume (p = 0.016) and a 37% decrease in surface area (p = 0.008) was observed. OCT indicated trends towards smoother scar surface (Ra 11.1-10.3; p = 0.61), normalized dermal microarchitecture (attenuation coefficient: 1.52-1.68; p = 0.44), and a reduction in blood flow between 9% and 17% (p = 0.50-0.79). Despite advances in VSS subscores and OCT, no improved photo-assessed cosmesis was found (-3.2 treatment vs. -1.4 control; p = 0.265). Patient-reported pain was low (2/10) and 90% of the patients that had previously received needle injections preferred PJI to needle injection. Depositions of TAC + FU were imaged reaching deep into the scar at levels corresponding to the reticular dermis. CONCLUSION: A single PJI injection containing 5-FU and TAC can significantly improve the height and pliability of HTS. PJI is favored by the patients and may serve as a complement to conventional needle injections, especially for patients with needle phobia.

Ballet clássico adaptado para mulher com hérnia de disco na região lombar: um relato de caso / Classical ballet adapted for women with disc herniation in the lower back: case report

Introdução: A hérnia discal lombar é o diagnóstico mais comum dentre as alterações degenerativas da coluna lombar. Dentre diversas formas de prevenção e tratamento para hérnia de disco, estão anti-inflamatórios, fisioterapia, acupuntura, antidepressivos, morfina e psicoterapia. O exercício físico pode ser efetivo, de baixo custo e um meio não farmacológico no tratamento. No entanto, existem muitas barreiras para a aceitação no uso específico da atividade física fora do ambiente clínico, como a dança e o esporte. Objetivo: Esse estudo de caso teve como objetivo analisar as contribuições do ballet clássico adaptado para a melhoria do quadro clínico da hérnia de disco lombar. Método: O estudo de caso foi composto por um roteiro feito pelos avaliadores e utilizado em uma mulher com 32 anos de idade, sem experiência na prática do Ballet Clássico. Os exercícios tiveram duração de 13 semanas, realizadas duas vezes por semana (duas horas em cada sessão), totalizando 26 sessões e um total de 52 horas de intervenção. Resultados: Mediante aos laudos médicos de ressonância magnética obtida pós-intervenção, constatou-se que, em relação ao exame anterior, houve redução das dimensões da hérnia discal no nível L4-L5. Já a escala de avaliação de dor visual analógica (EVA) foi de "dor máxima" no período pré intervenção para "sem dor" no pós intervenção. A escala de dor visual numérica (EVN) pré intervenção foi estabelecida em 9 "com dor" e pós intervenção em 2 "sem dor". A escala de dor de facial (EDF) pré intervenção foi estabelecida em fator 6 "com dor" e pós intervenção como fator 2 "sem dor". Conclusão: É possível concluir que após realização do programa de Ballet Clássico adaptado foi possível observar a diminuição dos valores na escala de dor e na dimensão da hérnia de disco da paciente avaliada.

Introduction: A herniated disc in the lower back is the most common diagnosis among degenerative alterations in the lumbar spine. Various forms of treatment for improvement of lumbar disc herniation, such as anti-inflammatories, physical therapy, acupuncture, antidepressants, morphine, and cognitive behavioral therapy. The physical exercise is an effective, inexpensive, and non-pharmacological tool. Although, there are still several barriers to accepting the use of specific physical exercises outside the clinical environment, such as dance and sports. Objective: This study aimed to analyze the contributions of classical ballet adapted to improve the clinical framework of lumbar disc herniation in a beginner student of classical ballet. Method: The case study composed for one script made by the evaluators was applied to an adult woman with 32 years old, who until that point had not practiced classical ballet. The exercises were performed twice a week (two hours for session) for a period of 13 weeks, totaling 26 sessions, giving a total exposure during the intervention of 52 hours. Results: The magnetic image obtained from medical reports after the intervention found that compared to the previous examination the disc herniation at level L4 ­ L5 was reduced in size. In addition, the visual analog pain scale (EVA) assessment pre intervention was maximum pain and post intervention was no pain. The numeric pain scale rating (NPS) pre intervention was number 9 with pain, and post intervention, number 2 painless. The Faces Pain Scales (FPS) pre intervention had a factor of 6 with pain, and post-intervention factor 2, painless. Conclusion: It is possible to conclude that the present script made by the evaluators was sufficient for cause the of herniation reduction in the evaluated patient post intervention.

A Comparison Between People With and Without Subacromial Impingement Syndrome and a New Method for Measuring Thoracolumbar Fascia Flexibility.

OBJECTIVE: The purpose of this study was to compare the flexibility of the thoracolumbar fascia (TLF) in individuals with and without subacromial impingement syndrome (SAIS). A secondary purpose was to demonstrate a new method for measuring TLF flexibility. METHODS: A total of 60 participants-30 diagnosed with SAIS and 30 asymptomatic-were included. In both groups, trunk flexibility was assessed by the modified Schober test, TLF flexibility by rotational measurement on a goniometric platform, and shoulder posterior capsule tightness by tape measurement. The data obtained were compared using t tests for independent variables. RESULTS: No statistically significant difference was observed for any parameter between participants with SAIS and healthy controls (P > .05). CONCLUSION: For the participants we studied, the flexibility of the TLF was not associated with SAIS. The goniometric evaluation method used in this study was affordable and feasible. The validity and reliability of this measurement method should be assessed further in future studies.

A comparison of the effects of different stretching methods on flexibility, muscle activity, and pain threshold in ballet dancers; a preliminary randomized controlled trial.

BACKGROUND: The purpose of this study is to compare the effects of stretching methods on flexibility, muscle activation, and pressure pain threshold in ballet dancers, and to suggest an effective stretching method. METHODS: Thirty-three ballet dancers were randomized to the static stretching group (n = 11), muscle energy technique stretching group (n = 11), and vibration-assisted stretching group (n = 11). The angle of hip joint extension in arabesque, activation of the rectus femoris in devéloppé, and pressure pain threshold on the rectus femoris in the sitting position were measured to compare the effects of the different stretching methods. Paired t-test was used to compare the pre and post-intervention findings within each group and one-way analysis of variance to compare the difference in the amount of changes among the groups. RESULTS: The hip joint extension angles increased in all stretching methods (p < 0.05); however, vibration-assisted stretching and muscle energy technique stretching were more effective than static stretching (p < 0.05). The activation of the rectus femoris decreased in all groups (p < 0.05); however the muscle energy technique stretching group and vibration-assisted stretching group showed a significant decrease in muscle activation compared with the static stretching group (p < 0.05). The pressure pain threshold significantly improved only in the static stretching group (p < 0.05); and vibration-assisted stretching group (p < 0.05). CONCLUSIONS: Compared with static stretching and muscle energy technique stretching, vibration-assisted stretching is a beneficial method for improving flexibility, muscle activation, and pressure pain threshold in ballet dancers.

Objective quantification of burn scar stiffness using shear-wave elastography: Initial evidence of validity.

Shear-wave elastography (SWE) is an ultrasound based technology that can provide reliable measurements (velocity) of scar stiffness. The aim of this research was to evaluate the concurrent validity of using both the measured velocity and the calculated difference in velocity between scars and matched controls, in addition to evaluating potential patient factors that may influence the interpretation of the measurements. METHODS: A cross-sectional study of 32 participants, with 48 burn scars and 48 matched contralateral control sites were evaluated with SWE, the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS) tactile sub-scores. RESULTS: Spearman's rho demonstrated high correlations (r > 0.7) between the measured scar velocity and both the POSAS and VSS pliability sub-scores, whereas moderate correlations (r > 0.6) were found with the calculated difference in velocity. Regression analysis indicated that the association of increased velocity in scars, varied by length of time after burn injury and gender. Body location and Fitzpatrick skin type also demonstrated significant associations with velocity, whereas age did not. CONCLUSION: SWE shows potential as a novel tool to quantify burn scar stiffness, however patient factors need to be considered when interpreting results. Further research is recommended on a larger variety of scars to support the findings.

A Novel, Reliable Protocol to Objectively Assess Scar Stiffness Using Shear Wave Elastography.

The aim of this research was to investigate the use of shear wave elastography as a novel tool to quantify and visualize scar stiffness after a burn. Increased scar stiffness is indicative of pathologic scarring which is associated with persistent pain, chronic itch and restricted range of movement. Fifty-five participants with a total of 96 scars and 69 contralateral normal skin sites were evaluated. A unique protocol was developed to enable imaging of the raised and uneven burn scars. Intra-rater and inter-rater reliability was excellent (intra-class correlation coefficient >0.97), and test-retest reliability was good (intra-class correlation coefficient >0.85). Shear wave elastography was able to differentiate between normal skin, pathologic scars and non-pathologic scars, with preliminary cutoff values identified. Significant correlations were found between shear wave velocity and subjective clinical scar assessment (r = 0.66). Shear wave elastography was able to provide unique information associated with pathologic scarring and shows promise as a clinical assessment and research tool.

Influência do arco longitudinal medial na distribuição plantar e na flexibilidade posterior / La influencia del arco longitudinal medial en la distribución plantar y la flexibilidad posterior / The influence of medium longitudinal arch on plant distribution and posterior pliability

RESUMO O objetivo deste estudo foi verificar se a formação do arco longitudinal do pé interfere na distribuição da pressão plantar e na flexibilidade dos músculos posteriores da coxa. O método de estudo foi transversal e as impressões plantares foram obtidas usando o plantígrafo e analisadas segundo o método Viladot. A distribuição plantar e a flexibilidade foram avaliadas pela baropodometria e pelo banco de Wells, respectivamente. Foi observado que crianças com pés cavos apresentam maior flexibilidade quando comparadas às que têm o pé normal (p=0,02); e também que pés cavos apresentam maior pressão, ou seja, maior sobrecarga em calcâneo quando comparados àqueles com o arco plantar normal (p=0,02 membro inferior direito e p=0,03 membro inferior esquerdo). A avaliação do arco longitudinal medial mostra que crianças com pés cavos apresentam maior flexibilidade dos músculos posteriores de membro inferior. Os pés cavos também estão associados com maior descarga de peso em região de calcâneo.

RESUMEN El objetivo de este estudio fue verificar si la formación del arco longitudinal del pie interfiere con la distribución de la presión plantar y la flexibilidad de los músculos posteriores del muslo. El método de estudio fue transversal y las huellas plantar se obtuvieron utilizando el plantigraph y se analizaron según el método de Viladot. La distribución plantar y la flexibilidad se evaluaron mediante baropodometría y el banco de Wells, respectivamente. Se observó que los niños con pies huecos tienen mayor flexibilidad en comparación con aquellos con pies normales (p=0,02); y también que los pies huecos tienen una mayor presión, es decir, una mayor sobrecarga del talón en comparación con aquellos con arco plantar normal (p=0,02 miembro inferior derecho y p=0,03 miembro inferior izquierdo). La evaluación del arco longitudinal medial muestra que los niños con pies huecos tienen una mayor flexibilidad en los músculos posteriores de la extremidad inferior. Los pies huecos también están asociados con una mayor descarga de peso en la región del talón.

ABSTRACT Objective: To evaluate whether the formation of the longitudinal arch of the foot interferes with the distribution of plantar pressure and the pliability of the posterior thigh muscles. Methodology: a cross-sectional study and the footprints were obtained using the footprinting mat and analyzed according to the Viladot method. Plantar distribution and pliability were assessed by baropodometry and Wells' bank, respectively. Results: It was observed that children with cavus feet present greater pliability when compared to those with normal feet (p=0.02). Also, the cavus feet exhibit higher pressure, that is, a greater heel overload compared to those with normal plantar arch (p=0.02 lower right limb and p=0.03 lower left limb). Conclusions: The evaluation of the medial longitudinal arch shows that children with cavus feet have greater pliability of the lower limb posterior muscles. The cavus feet are also associated with higher pressure in the calcaneal region.

Association of Neck Range of Motion and Skin Caliper Measures on Dysphagia Outcomes in Head and Neck Cancer and Effects of Neck Stretches and Swallowing Exercises.

To date, there is a paucity of information in the literature regarding the association between cervical range of motion (CROM) and skin caliper measures (SCM) and swallowing outcomes in post-RT individuals with head and neck cancer. Also lacking in the literature are reports of the effect of swallowing exercises and neck stretches on changes in CROM and SCM and their associations with swallowing outcomes. The aim of this study was to assess the associations between CROM and SCM before initiation of a neck stretching and swallowing exercise program and to determine if 12 weeks of twice daily practice changes in CROM and SCM were associated with changes in swallowing outcomes in a cohort of 119 head and neck cancer survivors. Primary results revealed that at baseline, greater right and left CROM were associated with lower penetration aspiration scale (PAS) scores (r = - 0.321, p = < 0.001; r = - 0.203, p = 0.026, respectively). Improved skin pliability revealed lower PAS scores (r = - 0.210, p = 0.022). After 12 weeks, there were no significant correlations between changes in CROM and SCM and PAS scores. Changes in left CROM and CROM extension had positive associations with the Head and Neck Cancer Inventory eating score (r = 0.210, p = 0.026; r = 0.245, p = 0.009, respectively). Findings appear to indicate that any improvement was not associated with changes in swallowing outcomes. Head and neck cancer survivors may perceive improved diet and swallowing skills through exercise, with respect to improved CROM extension.

Creativity and its determinants among medical students.

INTRODUCTION: The ultimate goal of education at all levels is the ability to generate and foster students' creativity. This study aimed at determining and comparing creativity and its influencing factors among medical students. SUBJECTS AND METHODS: In this cross-sectional study conducted in 2019, 720 medical students in Shahroud public and private universities were selected and studied through stratified cluster random sampling. Data were collected using the Guilford Creativity Questionnaire. The data were analyzed using Chi-square, Pearson correlation coefficient, t-test, and multiple logistic regression with a significance level of 0.05. RESULTS: The mean creativity score of the students was 131.4 ± 13.8. The mean creativity scores on the fluency, elaboration, originality, and flexibility dimensions were 49.2 ± 5.3, 22.1 ± 3.4, 34.8 ± 4.7, and 25.4 ± 3.5, respectively. In terms of creativity levels, 75.2% of the students (n = 542) had moderate creativity and 23.8% (n = 171) had high creativity. A significant relationship was observed between creativity and educational level (P = 0.006). Multiple logistic regression results showed that educational level with an odds ratio of 0.59 was associated with a decreased chance of creativity. CONCLUSION: Most of the students had moderate creativity. Moreover, among the factors examined in this study, variables other than the field of the study and educational level had no significant effect on students' creativity. Therefore, using collaborative and cooperative learning and problem-based learning strategies, teachers' critical thinking styles, establishing teamwork groups, concept mapping, and using innovative and creative teaching methods can help to enhance students' creativity.

Validity of flexicurve for the assessment of spinal flexibility in asymptomatic individuals / Validade do flexicurva na avaliação da flexibilidade da coluna vertebral em indivíduos assintomáticos / Validez del flexicurve en la evaluación de la flexibilidad de la columna vertebral en individuos asimomáticos

Abstract Introduction: Spine problems are common, and assessment of spine flexibility provides relevant information; however, alternative evaluation methods need to be validated. Objective: To evaluate the concurrent validity of the Flexicurve using 3D videogrammetry as a reference value to assess spinal flexion and extension in the lumbar and thoracic regions. Method: The consecutive sample consisted of 39 individuals aged between 18 and 50 years. Two consecutive evaluations were performed by the same rater on the same day and at the same location: (1) Flexicurve and (2) 3D videogrammetry. The assessments were performed with the spine in the neutral position, followed by maximum flexion and extension. The range of motion (ROM) in the maximum flexion and extension positions was calculated in MATLAB® and defined as the difference between the maximum flexion or extension angle and that of the neutral position. Statistical analyses used were the Pearson Product-Moment Correlation coefficient, RMS error and Bland-Altman plot (α < 0.05). Results: The ROM between instruments was similar, with high correlations for thoracic flexion (r = 0.751), extension (r = 0.814) and lumbar flexion (r = 0.853), and RMS errors under 8°. The correlation for lumbar extension was moderate (r = 0.613) and the RMS error was more than 10°. The limits of agreement varied between ± 10º and ± 21º. Conclusion: The Flexicurve is valid for assessing maximum flexion and extension of the thoracic spine, and maximum flexion of the lumbar spine. We suggest caution in evaluating the maximum extension of the lumbar spine.

Resumo Introdução: Problemas na coluna vertebral são frequentes, sendo a avaliação da flexibilidade uma informação relevante a ser considerada pelo profissional. Métodos alternativos para realizar avaliação da flexibilidade da coluna carecem de validação. Objetivo: Avaliar a validade concorrente do Flexicurva utilizando a videogrametria 3D como medida de referência, para a avaliação da flexibilidade em flexão e extensão da coluna vertebral torácica e lombar. Método: A amostra consecutiva contou com 39 indivíduos com idades entre 18 e 50 anos. Duas avaliações consecutivas foram realizadas pelo mesmo avaliador no mesmo dia e local: (1) Flexicurva e (2) videogrametria 3D. As avaliações foram realizadas com a coluna na posição neutra, seguida das posições de flexão e extensão máximas. A ADM nas posições de flexão e extensão máximas foram calculadas no MATLAB®, sendo definida como a diferença entre os ângulos máximos de flexão ou extensão e a angulação da posição neutra. Na análise estatística utilizou-se: Teste de Correlação Produto-Momento de Pearson, Erro RMS e Análise de Bland-Altman. (α < 0,05). Resultados: Os valores de ADM entre os instrumentos foram similares, com correlações altas para a flexão torácica (r = 0,751), extensão torácica (r = 0,814) e para flexão lombar (r = 0,853), com erros RMS inferiores a 8°. Para a extensão lombar a correlação foi moderada (r = 0,613), com erro RMS superior a 10°. Limites de concordância variaram entre ± 10º e ± 21º. Conclusão: O Flexicurva mostrou-se válido para avaliar o movimento flexão máxima e extensão máxima da coluna torácica, e flexão máxima da coluna lombar. Sugerimos cautela na avaliação da extensão máxima da coluna lombar.

Resumen Introducción: Los problemas en la columna vertebral son frecuentes, siendo la evaluación de la flexibilidad de la columna vertebral una información relevante a ser considerada por el profesional. Los métodos alternativos para realizar la evaluación de la flexibilidad de la columna necesitan validación. Objetivo: Evaluar la validez concurrente del Flexicurva utilizando la videogrametría 3D como medida de referencia para evaluar la flexión y extensión de la columna en las regiones lumbar y torácica. Método: La muestra consecutiva consistió en 39 individuos de edades comprendidas entre 18 y 50 años. El mismo evaluador realizó dos evaluaciones consecutivas en el mismo día y local: (1) Flexicurve (2) Videogrametría 3D. Las evaluaciones se realizaron con la columna en posición neutral seguida de la máxima flexión y extensión. El RDM en la posición máxima de flexión y extensión se calculó en MATLAB®, la flexión máxima y la extensión se definieron como la diferencia entre el ángulo de la posición con respecto al punto neutro. Los análisis estadísticos consistieron en la prueba de correlación de producto-momento de Pearson, error de RMS y los análisis de Bland-Altman (α < 0,05). Resultados: Los valores de RDM entre instrumentos fueron similares, con altas correlaciones para flexión torácica (r = 0.751), extensión torácica (r = 0.814) y flexión lumbar (r = 0.853), y errores RMS por debajo de 8°. Para la extensión lumbar, se moderó la correlación (r = 0,613) y el error RMS fue superior a 10°. Los límites de concordancia variaron entre ± 10º y ± 21º. Conclusión: El Flexicurva se mostró válido para evaluar la flexión máxima y la extensión máxima de la columna torácica, y la flexión máxima de la columna lumbar. Sugerimos precaución al evaluar la extensión máxima de la columna lumbar.

Influence of heat treatment on color and flexibility of nickel-titanium endodontic instruments / Influência do tratamento térmico na cor e flexibilidade de instrumentos endodônticos de níquel-titânio

ABSTRACT Objective The aim of this study was to evaluate and compare the effect of heat treatment at different temperatures on the color and flexibility of nickel-titanium endodontic instruments. Methods Thirty-six nickel-titanium K-file endodontic instruments were divided into six groups and submitted to heat treatment at several temperatures between 450ºC and 750ºC. The color was visually observed. Cantilever-bending tests were performed to measure the flexibility of the instruments. The data were statistically evaluated by one-way analysis of variance and Tukey post hoc comparisons. Results It was observed that the color becomes darker as the heating temperature increases. The flexibility is significantly higher after the heat treatment (P < 0.05). Instruments treated at 650ºC and 750ºC had higher flexibility than those treated at lower temperatures (450ºC, 500ºC and 550ºC) (P < 0.05). Conclusion Heat treatment has a significant effect on the surface color and flexibility of nickel-titanium endodontic instruments. The highest flexibility was observed in instruments heated at 650ºC and 750ºC.

RESUMO Objetivo O objetivo deste estudo foi avaliar e comparar o efeito do tratamento térmico realizado em diferentes temperaturas sobre a cor e a flexibilidade dos instrumentos endodà´nticos de níquel-titânio. Métodos Trinta e seis instrumentos endodônticos de níquel-titânio tipo K foram divididos em seis grupos e submetidos ao tratamento térmico com temperaturas variando entre 450ºC e 750ºC. A cor dos instrumentos após tratamento foi visualmente observada. Testes de flexão em 45º foram realizados para medir a flexibilidade dos instrumentos. Os dados foram avaliados estatisticamente através de anà¡lise de vâriancia (ANOVA) com teste post hoc de Tukey. Resultados Observou-se que os instrumentos apresentaram cor mais escura à medida que a temperatura de aquecimento foi aumentada. A flexibilidade é significativamente maior em instrumentos submetidos ao tratamento térmico (P < 0,05). Os instrumentos tratados a 650ºC e 750ºC tiveram maior flexibilidade do que aqueles tratados em baixas temperaturas (450ºC, 500ºC e 550ºC) (P < 0,05). Conclusào O tratamento térmico afeta significativamente a cor apresentada pela superfície dos instrumentos endodà´nticos de níquel-titânio e sua flexibilidade. A maior flexibilidade foi observada em instrumentos tratados nas temperaturas de 650ºC e 750ºC.

Efeito agudo de diferentes métodos de termoterapia na amplitude de movimento articular / Acute effect of different thermotherapy methods on articular range of motion

Objetivo O objetivo deste estudo foi comparar quantitativamente o efeito agudo de diferentes técnicas de termoterapia no ganho da amplitude de movimento. Participaram da pesquisa voluntários (n=34) de ambos os sexos e média de idade de 22,3 anos (±3,3 anos). Métodos Os participantes foram divididos aleatoriamente em dois grupos: em um grupo, os indivíduos foram submetidos a aplicação da lâmpada infravermelha (calor superfi cial), enquanto no outro grupo utilizou-se o aparelho de ondas curtas (calor profundo) como técnica de termoterapia. Resultados Como resultado, observou-se que o grupo submetido ao calor profundo obteve melhora significante em relação a amplitude de movimento, tanto em comparação dentro do mesmo grupo, confrontando-se a amplitude de movimento pré- e pós-intervenção (aumento médio de 10,9+3,1º), quanto quando comparado ao grupo submetido ao calor superficial, que não apresentou melhora significativa (aumento médio de 3,1+2,5º). Conclusão Concluiu-se que, embora o efeito agudo da termoterapia seja benéfico no ganho de amplitude de movimento, o calor profundo parece ter um efeito mais pronunciado quando comparado às técnicas de calor superficial.

Objective The objective of this study was to quantitatively compare the acute effect of different thermotherapy techniques on the gain of range of motion. Methods Research volunteers (n=34) of both genders and mean age of 22.3 years (±3.3 years) were randomly divided into two groups: one group in which subjects were treated with infrared lamp (surface heat) while the other group was treated with the selected thermotherapy technique with the shortwave apparatus (deep heat). Results The deep heat group obtained a significant improvement in terms of range of motion, both within the same group, comparing the pre and post intervention range of motion (mean increase of 10.9±3.1º) when compared to the superficial heat group, which in turn did not show significant improvement (mean increase of 3.1+2.5º). Conclusion Although the acute effect of thermotherapy is beneficial in gain of range of motion, deep heat seems to have a more pronounced effect when compared to surface heat techniques

In-vitro pliability assessment of embolization coils for intracranial aneurysm treatment.

BACKGROUND: Embolization coils have routinely been used to treat intracranial aneurysms via an endovascular approach. Soft coils are typically viewed as the best design for filling and finishing the aneurysms to achieve a higher packing density and are hypothesized to exert a lower force against the aneurysm wall during deployment. We report here an in vitro pliability test method to assess clinically relevant coil softness and compare these metrics for two commercially available framing and finishing coil products. METHODS: A force measurement sensor was affixed onto a side-wall synthetic aneurysm model to continuously measure forces on the aneurysm wall during coil deployment at a fixed delivery rate. A quantitative overall energy metric (average work number or AWN) was calculated from the force-displacement graph representing coil delivery into the aneurysm. Two groups of coils were evaluated: (a) finish coil group (N = 20 ea.): Axium™ Prime Extra Soft coil (ES) and Target™ 360 Nano coil (Nano), and (b) frame coil group (N = 20 ea.): Axium™ Prime FC coil (FC) and Target™ 360 Standard coil (Standard). RESULTS: (a) In the finish coil group, AWN was measured as: ES (0.53 ±â€¯0.09 gf-cm) and Nano (0.99 ±â€¯0.21 gf-cm). (b) In the frame coil group, AWN was measured as FC (2.54 ±â€¯0.53 gf-cm) and Standard (4.48 ±â€¯0.52 gf-cm). In both groups, Axium Prime coils had statistically lower measures of AWN and therefore higher pliability compared to Target coils (p < .001). CONCLUSIONS: The in-vitro pliability test method offers quantitative metrics to assess coil softness during deployment in a clinically relevant aneurysm model.