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.

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.

Managing Pathologic Scars by Injecting Auto-Cross-linked Hyaluronic Acid: A Preliminary Prospective Clinical Study.

BACKGROUND: Pathological scars are unattractive and may significantly impair the patient's quality of life. Current treatments provide inconsistent results, and none may be regarded as definitive. Recently, an auto-cross-linked hyaluronic acid (HA) formulation, IAL-SYSTEM ACP, featuring a long residence time and an enhanced safety profile, has been successfully used to prevent surgical adhesions, treat tendon lesions and rejuvenate the face and the décolletage. This study aims to preliminarily investigate whether IAL-SYSTEM ACP may also be effective in treating pathological scars resulting from burns, trauma or iatrogenic causes. METHODS: Patients presenting one pathological scar were prospectively recruited and treated with two IAL-SYSTEM ACP injections carried out two weeks apart. Scar improvement was measured comparing the patient and observer scar assessment scale (POSAS) scores collected before treatment (T0) and 90 days after the second injection (T90) using nonparametric tests. The effect of age and scar type over score variation was investigated through quantile regression analysis. RESULTS: Forty-one patients, 10 women and 31 men (median age, 34 years) were recruited. No patient dropped out, and no significant adverse event was observed. At T90, the median observer total score decreased by 11 units (- 77.5%) and the median patient total score decreased by 15 units (- 73.7%). The difference was significant (p < 0.001) in both cases. Traumatic injuries and young patient's age were the most significant predictors of a positive treatment outcome. CONCLUSIONS: Treatment of pathological scars by two IAL-SYSTEM ACP injections, carried out two weeks apart, may provide significant clinical benefits. These findings should be the subject of further investigations. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Pathophysiology of Fibrosis in the Vocal Fold: Current Research, Future Treatment Strategies, and Obstacles to Restoring Vocal Fold Pliability.

Communication by voice depends on symmetrical vibrations within the vocal folds (VFs) and is indispensable for various occupations. VF scarring is one of the main reasons for permanent dysphonia and results from injury to the unique layered structure of the VFs. The increased collagen and decreased hyaluronic acid within VF scars lead to a loss of pliability of the VFs and significantly decreases their capacity to vibrate. As there is currently no definitive treatment for VF scarring, regenerative medicine and tissue engineering have become increasingly important research areas within otolaryngology. Several recent reviews have described the problem of VF scarring and various possible solutions, including tissue engineered cells and tissues, biomaterial implants, stem cells, growth factors, anti-inflammatory cytokines antifibrotic agents. Despite considerable research progress, these technical advances have not been established as routine clinical procedures. This review focuses on emerging techniques for restoring VF pliability using various approaches. We discuss our studies on interactions among adipose-derived stem/stromal cells, antifibrotic agents, and VF fibroblasts using an in vitro model. We also identify some obstacles to advances in research.

Measurements of scar properties by SkinFibroMeter® , SkinGlossMeter® , and Mexameter® and comparison with Vancouver Scar Scale.

BACKGROUND: An objective measurement of scar is important for evaluating treatment outcomes. However, to date, there is no 'gold standard' for quantitative measurement of properties of hypertrophic scar. Existing objective modalities are neither portable nor easy to use. OBJECTIVE: This study aims to validate the correlation between objective measurements with SkinFibrometer® , SkinGlossMeter® , and Mexameter® and subjective assessment with Vancouver Scar Scale (VSS) of keloid and hypertrophic scar. METHODS: A total of 25 patients with keloids and hypertrophic scars were enrolled in this study. Patients were treated with intralesional triamcinolone acetonide at 2-6 week intervals. Scar assessments using VSS, Skinfibrometer, Skinglossmeter, and Mexameter were performed in both scars and contralateral normal skin at each treatment session. Correlations between the measurements by these tools and VSS parameters were examined. RESULTS: We found statistically significant differences between scar and contralateral normal skin using Skinfibrometer, Skinglossmeter, and Mexameter. A strong correlation was found between the VSS pliability scores and the stiffness of skin of Skinfibrometer (r = 0.628, P < 0.001). VSS vascularity scores showed weak correlation with erythema index of Mexameter (r = 0.372, P < 0.001). However, no correlation appeared to exist between any parameters of VSS and Skinglossmeter and between VSS pigmentation scores and the melanin index of Mexameter. CONCLUSION: In our study, Skinfibrometer can be an objective noninvasive evaluation tool for pliability of the scar.

[Pliability and deflection of diagnostic catheters]. / Szívkatéterek hajlékonysága, meghajlítása.

INTRODUCTION: The cardiac catheter is an intravascular catheter, which is introduced or implanted into the heart for diagnostic or therapeutic reasons. The catheters may break or king during their introduction and/or removal. AIM: The aim of the authors was to study the pliability of two catheters with the same material but different diameters according to the Food and Drug Administration's recommendation. METHOD: The bending points, diameter decrease, deflection, and their correlation and dependence on the distance from the tip, as well as the influence of the initial diameter of the catheters were determined. The bending of catheters was performed on 9 bending points (120-280 mm from the tip by 20 mm) on 16 gauges with different radius (10-2.5 mm by 0.5 mm). RESULTS: A linear dependency between the diameter decrease and deflection was observed, which was independent from the placement of the measurement in both catheters examined. The larger initial diameter had significant (p = 0.05) greater diameter decrease than the smaller, but the curves characteristic of the diameter decrease and deflection were similar. CONCLUSIONS: The applied method seems to be useful for the examination of weak points of cardiac catheters.

Suction-Based Optical Coherence Elastography for the Biomechanical Characterization of Pathological Skin Conditions: A Pilot Study.

Accurate characterization of mechanical properties is crucial in the evaluation of therapeutic effects for problematic skin conditions. A pilot study was carried out using a novel optical coherence elastography (OCE) device, combining mechanical characterization through suction-based deformation and imaging through optical coherence tomography. Using AI-assisted image segmentation and a power-law model, we were able to describe the mechanical behavior, comparing with measurements from the most commonly used commercial instrument (Cutometer) and subjective analyses of stiffness using the Patient and Observer Scar Assessment Scale. Twenty subjects were included with either keloids or hypertrophic scars. Measurements were fast and produced no discomfort. Mechanical and structural (epidermal thickness and rugosity) descriptors in pathologic skin conditions differed significantly from those in control tissue. We showed for the first time, the clinical feasibility of this novel suction-based OCE device in evaluating mechanical and structural properties in pathological skin conditions such as scars.

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.

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.

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.

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.

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.

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.

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.

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.

Efeito da auto liberação miofascial na flexibilidade de escolares: uma proposta acessível / Effects of self myofascial release on the flexibility of students: an accessible proposal

RESUMO Diversas pesquisas têm avaliado a aplicabilidade da técnica de auto liberação miofascial (ALM) na melhora aguda da flexibilidade em inúmeros esportes e/ou populações diferentes. No entanto, torna-se difícil sua inserção nas aulas de educação física escolar pelo elevado custo dos materiais. Dessa forma, buscou-se investigar o efeito da ALM em escolares por meio da utilização de rolos de espumas originais e com rolos confeccionados com materiais adaptados de baixo custo. Participaram da pesquisa 30 escolares, que foram aleatoriamente agrupados em: Grupo Controle (GCT), Grupo Rolo Original (GRO) e Grupo Rolo Adaptado (GRA). A flexibilidade foi avaliada antes e após a aplicação da ALM. A ALM foi realizada em músculos alvos uma vez por 30 segundos com intervalos de 15 segundos entre os estímulos. As comparações na flexibilidade pré e pós ALM foram avaliadas utilizando o teste de t student, com nível de significância adotado de p<0,05. Verificou-se que a ALM no GRO e GRA aumentaram agudamente a flexibilidade dos escolares em 7,53 e 16,5%, respectivamente. Assim, a utilização de rolos confeccionados com material alternativo (adaptado) para aplicação da ALM se mostra uma forma mais acessível financeiramente para ser utilizada nas aulas de educação física e abre possibilidades para sua aplicação para além das escolas.

ABSTRACT Several studies have assessed the applicability of the Myofascial Self-Release Technique (MSRT) in the acute improvement of flexibility in various sports and/or different populations. However, its integration into school physical education classes becomes challenging due to the high cost of materials. Therefore, the aim was to investigate the effect of MSRT on schoolchildren using both original foam rollers and rollers made from low-cost adapted materials. Thirty schoolchildren participated in the study and were randomly grouped into: Control Group (CG), Original Roller Group (ORG), and Adapted Roller Group (ARG). Flexibility was evaluated before and after the application of MSRT. MSRT was performed on target muscles once for 30 seconds with intervals of 15 seconds between stimuli. Comparisons in pre- and post-MSRT flexibility were assessed using the Student's t-test, with a significance level adopted of p <0.05. It was found that MSRT in ORG and ARG significantly increased schoolchildren's flexibility by 7.53% and 16.5%, respectively. Therefore, the use of rollers made with alternative (adapted) material for applying MSRT appears to be a more financially accessible way to be used in physical education classes and opens possibilities for its application beyond schools.

Objective and quantifiable measuring mechanism for assessing flap pliability: Our experience with 92 patients.

BACKGROUND: Pliability describes a flaps' ability to bend under spatial limitations, yet a quantifiable measurement for this flexibility does not exist. METHODS: Between January 2015 and January 2017, we applied a novel measuring mechanism to two free flaps for head and neck reconstruction. We allocated a flap pliability score (FPS) to these flaps and observed correlations to common variables. RESULTS: Forty profunda artery perforator (PAP) and 52 anterolateral thigh (ALT) flaps were allotted a score depending on how pliable they performed on our test. Proximal PAP and distal ALT were more pliable than their respective opposite ends. Other interesting conclusions regarding these flaps were also made. CONCLUSIONS: With our technique, pliability of the proximal and distal ends of PAP and ALT flaps was ascertained. Herein, we describe an innovative measuring mechanism via which we can allocate a FPS to any flap and thus obtain information regarding how suitable they are for a given recipient site.