Peak Apical Recoil Rate is a Simplified Index of Left Ventricular Untwist: Validation and Application for Assessment of Diastolic Function in Children

AimsTo simplify measurement of untwist by measuring the recoil rate of LV apex only, to validate and apply peak apical recoil rate (PARR) as an index of diastolic dysfunction (DD) in pediatric subjects during increased and decreased lusitropic states. Methods and ResultsWe recruited 153 healthy subjects (mean age 13.8+2.9 years), of whom 48 performed straight leg raising exercise and an additional 46 patients (mean 8.4+5.6 years) with documented pulmonary capillary wedge pressures (PCWP) (validation cohort). In addition, we studied 16 dilated cardiomyopathy patients (mean age 9.5+6.3years) (application cohort). PARR and isovolumic relaxation time (IVRT) were compared to PCWP. Both PARR and PARR normalized by heart rate (nPARR) were excellent in detecting patient with PCWP >12 mmHg and greatly superior to IVRT in this respect (AUC: 0.98, 95% CI [0.96, 1.0] vs. AUC: 0.7 95%CI [0.54,0.86]). In DCM patients, PARR and nPARR were greatly decreased compared to controls (-38.58+18.59º/s vs -63.07+16.35º /s, p< 0.001) and (-0.43+0.20 º/ s/min vs -0.83+0.28º/s/min, p<0.0001) but increased with straight leg raising exercise (-59.4+19.4º/s vs -97.82+39.0 º/s, p<0.01) and -0.85+0.36 vs -1.4+0.62 º/s/min (p< 0.0001). The intra-observer and inter-observer intraclass correlation (ICC) coefficients were 0.95 and 0.88, respectively.ConclusionPARR successfully detected increased and decreased lusitropic states and was not affected by age when normalized with heart rate. Both PARR and nPARR are superior to IVRT in their correlation with PCWP and offer incremental value over traditional indices of DD. This highly reproducible parameter may potentially serve as a useful index of elevated PCWP in children.

Benign Fibrous Histiocytoma of the Sacrum: A Rare Scenario

Benign fibrous histiocytoma (BFH) of bone is quite rare, and here we report the second case of such tumor originating from sacrum, with the first being reported in an 18-year-old female. The overlapping clinical, radiological, and histopathological findings make it a difficult diagnosis along with the fact that it is a rare diagnosis. In this case report, we present the diagnostic difficulties and optimal treatment for such cases. A 46-year-old male w presented to OPD with complaint of numbness in left foot since 1 month, and intermittent urinary incontinence for 2 weeks. On examination, the straight leg raising test was positive of left side, extensor hallucis longus (EHL) was weak in both lower limbs, and bilateral ankle jerks were diminished. MRI showed well-defined lobulated solid mass lesion, which is T1 hypointense and T2 hyperintense and homogeneously involving the S1 vertebral body, with involvement of the right sacral ala, and right sacral foramen seen at S1 and S2 levels extending into the spinal canal till L4 level. Excision through a posterior midline incision was performed taking care to preserve the traversing nerves. Postoperatively, remarkable improvement in pain with no major residual neurological deficit was observed. Patient was followed-up till 9 months; patient’s incontinence improved over a period of 3 months and has stayed the same until the last follow-up.

EFFICACY OF AABHADI CHURNA ALONG WITH PATHYA AAHARA AND VIHARA IN GRIDHRASI W.S.R. TO SCIATICA - A RESEARCH ARTICLE

Nowadays due to changing lifestyle, lack of physical activity and long sitting postures lead to a disease called Gridhrasi. Symptoms of Gridhrasi closely resemble the clinical features of Sciatica. Sciatica is a severely painful condition where the sciatic nerve of one or both legs is involved. This study was undertaken to evaluate the clinical efficacy of Aabhadi Churna along with Pathya Aahara and Vihara in Gridhrasi with special reference to Sciatica. The study was conducted on 60 patients who fulfilled the diagnostic and inclusive criteria of sciatica. The clinical assessment was based on subjective parameters (Ruka, Stambha, Toda, Spandana) and objective parameters (Straight leg raising test, standing time and walking time). The subjective and objective parameters before and after treatment were analyzed by using the student "t" test. The t-test results were highly significant for both the groups when the therapy effect was compared before and after the treatment. The inter-group comparison showed that the Group-B treatment method where 84% of patients showed moderate to maximum improvement method was better when compared to Group-A where this percentage was 67% only. Keywords: Gridhrasi, Sciatica, Pathya Aahara, Vihara, Aabhadi Churna.

Preoperative characteristics and intraoperative factors do not correlate with accomplishments of active straight-leg raising, standing up, and walking after primary total knee arthroplasty

Background The correlations between patient characteristics and early postoperative functional performances after total knee arthroplasty have not been adequately studied. The purpose of this study was to clarify the effects of preoperative characteristics (sex, age, body mass index, American Society of Anesthesiologists grade, hospital for special surgery score) and intraoperative factors (duration of surgery and tourniquet use) on the time required to accomplish active straight-leg-raising, standing up, and walking as the objective performances for the initiation of early postoperative rehabilitation. Methods This cross-sectional retrospective study included 307 patients (384 primary total knee arthroplasties). Postoperative times required until each activity was accomplished were measured. Various preoperative characteristics and intraoperative factors that might affect three objective performances were evaluated. Results The postoperative times required before each activity was accomplished were 1.5 ± 0.5 days for active straight-leg-raising, 1.2 ± 0.5 days for standing up, and 1.4 ± 0.7 days for walking. There were no significant correlations between any factor (age, body mass index, hospital for special surgery score, duration of surgery, and tourniquet use) and the three objective performances using Spearman’s correlation coefficient. There were no differences in sex or American Society of Anesthesiologists grade for three objective functional assessments by Wilcoxon rank sum test. Conclusions Differences in patient preoperative characteristics and intraoperative factors are unlikely to affect three objective functional performances in the early postoperative period. Therefore, there is no need to consider differences between patients when initiating early postoperative rehabilitation.

Comparative Clinical Trial on Aragwadha Erand and Trivrutta Eranda Nitya Virechana in Gridhrasi (Lumbago Sciatica Syndrome): A Study Protocol

Background: At present, the life style is gradually shifting away from healthy living, and therefore people fall victim of various diseases. Sedentary lifestyle, stress, improper posture, continuous jerky movements, long travelling, etc., put maximum pressure on the spine and lower portion of the pelvis. About 80–90% of people get affected by low back pain and 5% of those become victims of sciatica. Aim: Studying the effect of Trivrut Eranda Tailam and Aragvadha Eranda Tailam Virechana in Gridhrasi (Lumbago sciatica syndrome). Objectives: To study the effect of Trivrut Eranda Tailam in Gridhrasi, To study the effect of Aragvadha Eranda Tailam in Gridhrasi and to compare the effect of Trivrutta Eranda Tailam and Aragavadha Eranda Tailam in Gridhrasi. Methodology: This study will be a Randomized controlled interventional trial to be conducted on 30 participants. The participants will be divided into two groups viz. Group A and Group B. The patient in Group A will be given Trivrutt Eranda Tailam (15 patients) and Group B will be given Aragvadha Eranda Tailam (15 patients). Results: Nitya virechan will be carried out in both these groups. The results will be compared on the basis of SLR test [Straight leg raising test], Lassegue sign, Flip test, Bowstring test and Serum electrolytes used for Gridhrasi. Conclusion: Conclusions will be drawn on the result.

Study on Efficacy and Safety of Shi’s Manual Therapy Treatment for Lumbar Disc Herniation with Radiculopathy: Study Protocol for A Multicenter Randomized Controlled Trial

Background Lumbar disc herniation (LDH) is a common chronic musculoskeletal disorder that seriously affects quality of life. Percutaneous endoscopic lumbar diskectomy (PELD) technique was developed to address spine nerve root compression by direct visualization of pathological findings while minimizing tissue destruction upon exposure. It is an effective and safe treatment for LDH. However, recurrent LDH is a major concern after lumbar discectomy for primary LDH. A considerable number of clinical studies reported that patients will benefit from manual therapy practice for LDH with radiculopathy patients. Shi's manual therapy (SMT) is established based on the Traditional Chinese medicine (TCM) theory, which has been shown to have a superior effect in alleviating muscle tension and loosen joints to improve lumbar and leg pain, radiculopathy, stiffness, activity discomfort, and related disorders. But there is a lack of high-quality clinical evidences to support the conclusion. The purpose of this study will be to evaluate the efficacy and safety of the combination of Shi’ manual therapy (SMT) for reducing the recurrent rate of LDH with radiculopathy. Methods/design: A multicenter randomized controlled trial (RCT) with a 1years’ follow-up period will be performed. A total of 510 participants with LDH with radiculopathy will be recruited in four clinical centers. Sample size estimation was calculated and statistical analysis will be performed calculated and supervised by biostatisticians from the independent third-party research institution. Two hundred and fifty-five subjects will be randomly allocated to each group. The subject in the control group will undergo the PELD. Participants in the intervention group will be treated with SMT, and the straight leg raising angle will be evaluated. If the patients’ straight leg raising the angle of the affected side is close to the healthy side, and the treatment is finished, if not, the PELD procedure will proceed. The primary outcome will be the recurrence rate of LDH with radiculopathy and the ODI score. The secondary outcome measures will be the VAS score for the pain of lumbar and lower limbs, the straight leg raising angle, the stability of the operated lumbar segment, and SF-36 scores. Assessments will occur at baseline, post-operation, and at 1week, 4 weeks, 13 weeks, 26 weeks and 1year post-operation. In addition, adverse events related to clinical symptoms and signs and results of laboratory tests will be documented during the clinical trials. Discussion This study will provide reliable evidence of the effectiveness and safety of the combination of SMT and PELD for LDH with radiculopathy. If the results are favorable, it is expected that the patients with LDH with radiculopathy will benefit from this study, many patients may have a good alternative treatment for LDH with radiculopathy. Trial registration: ChiCTR, ChiCTR2000036515. Registered on 13 November 2020.

A comparison of the effects of static stretching and the Fascial Distortion Model on hamstring flexibility

BACKGROUND: Hamstring flexibility plays a significant role in physiotherapy. Various stretching studies have been conducted to increase hamstring flexibility, but the effects of the Fascial Distortion Model (FDM) on hamstring flexibility have not yet been investigated. Moreover, no studies have compared the effects of FDM and static stretching. OBJECTIVES: To investigate the effects of the FDM on hamstring flexibility compared with static stretching. METHODS: Thirthy healthy adults were divided into two groups: static stretching and FDM groups. Static stretching was performed to hamstring in the supine position. The FDM was performed using trigger band techniques that followed the hamstring in a longitudinal direction. Hamstring flexibility was measured using the active knee extension angle (KEA), passive straight leg raising (SLR), sit-and-reach (SR), and finger-floor distance (FFD) tests. A paired t-test and an independent t-test were performed to compare the hamstring flexibility measurements. RESULTS: Both groups showed significant differences (p< 0.05) in KEA, SLR, SR, and FFD before and after. However, no significant difference (p> 0.05) was found between the two groups. CONCLUSIONS: There was no difference in the effects of FDM and static stretching on hamstring flexibility.

Evidence for the BUAS-test ability to diagnose lumbar radicular pain

Background: Differential diagnosis of low back pain (LBP) is complex and a prominent issue at all health-care levels; guidance may come from patients’ history cues and clinical examination signs. Human and animal studies report that diagnosis of lumbar radicular pain (LRP) may come from evaluating subjective responses of injured lumbar nerves to a strain applied at the buttock. The Buttock Applied Strain (BUAS-test) test may guide the differential diagnosis of LBP. Following an ex-adiuvantibus criterion, clinical improvement of LRP, diagnosed with the BUAS-test and congruently treated, may support this test diagnostic ability. Methods: Among 258 LRP patients, who, upon first visit (V1), tested positive on the BUAS-test (with/without positive Straight Leg Raising Test, SLRT), the effect of gabapentin prescription on painDETECT (PD) questionnaire and Brief Pain Inventory (BPI) outcomes was quantified in the follow-up visit (V2). To support BUAS-test diagnostic ability, we hypothesized that, at V2, >50% of the sample would present negative PD outcome, significant ( t-test) and ⩾2 points V2-V1 differences for each of the BPI-item’s score. We used multinomial logistic regression (MLR) and χ2 analyses to evaluate the PD-V2 outcomes’ dependence upon independent variables. Results: Of the sample, 77% reported a negative PD-V2 outcome. V2-V1 differences of all BPI items were significant and >2 points. PD-V2 outcomes showed significant associations with SLRT-V1 and PD-V1, respectively, but not with gender, age group or pain site. MLR showed a significant relationship between SLRT-V1 and PD-V2 outcomes. Conclusion: Among LRP patients, diagnosed by the BUAS-test and treated with gabapentin, all prespecified endpoints were reached. These results may be considered a piece of ex-adiuvantibus evidence for the BUAS-test ability to diagnose LRP. While positive BUAS-test implies potential LRP, the co-presence with positive SLRT may imply a severer LRP condition. Further prospective research, in different settings and direct clinical measures, is needed.