Anterior Research Articles

Significantly smaller lateral extrusion was observed within 24 weeks after all-inside suture repairs of radial tear in the middle segment of lateral meniscus compared to inside-out repairs.

To evaluate the postoperative meniscal extrusion between all-inside suture (AIS) and trans-capsular suture (TCS) repair techniques. Thirteen patients (mean age, 19.4 years) underwent AIS repairs using only sutures (AIS group) for radial tears in the middle segment of the lateral meniscus (RTMLM), and seven patients (mean age, 20.3 years) underwent inside-out repairs among TCS (TCS group). For all cases, lateral (LE), anterior (AE) and posterior (PE) meniscal extrusions of the lateral meniscus were measured during preoperative and 3-, 12- and 24-week postoperative MRIs. Then, the change of each extrusion from preoperative to each postoperative period was calculated as ∆LE, ∆AE and ∆PE. There was no significant difference between the AIS and TCS groups in the preoperative extrusions. As for postoperative extrusions, only ∆LEs in the AIS group was significantly smaller than those in the TCS group at all postoperative periods (-1.5 ± 1.7 vs. 0.9 ± 0.7 mm at 3-week, -0.9 ± 0.9 vs. 0.4 ± 0.9 mm at 12-week and -0.3 ± 1.0 vs. 0.6 ± 1.1 mm at 24-week postoperation). In ∆AEs and ∆PEs, at all three postoperative periods, there were no significant differences. Postoperative LE, AE and PE on MRIs after AIS and TCS repairs for RTMLM were investigated. Significantly smaller lateral extrusion was observed within 24 weeks after AIS repairs of RTMLM compared to TCS repairs, which could lead to stabilization of the repair site and prevent degenerative changes. Case-control study, retrospective comparative study, Level Ⅲ.

Assessing muscle energy technique and foam roller self-myofascial release for low back pain management in two-wheeler riders.

Pain in the lower back is a major concern in today's era due to prolonged sitting in two-wheeler riders, mainly due to hamstring tightness. It also creates physical disability and impairment in activities of daily living. The study aimed to compare the efficacy of muscle energy technique (MET) and self-myofascial release (SMFR) using the foam roller on hamstring flexibility, dynamic balance, and physical disability amongst two-wheeler riders with chronic low back pain (LBP). Participants were randomized into two intervention groups, MET and SMFR using the envelope method, with each group having 20 participants. Hamstring flexibility and range of motion for knee extension and the lower back were assessed using the active knee extension test (AKE-L and AKE-R) and sit and reach test (SRT), while the dynamic balance was assessed by the star excursion balance test (SEBT) and physical disability by Roland-Morris Disability Questionnaire, (RMDQ). Measurements were taken at baseline and after 4 weeks of intervention. This study demonstrated that both SMFR using a foam roller and MET are effective in enhancing hamstring muscle flexibility, (SRT-F(1, 38) = 299.5, p < 0.001; AKE-R-F(1, 38) = 99.53, p < 0.001; AKE-L-F(1, 38) = 89.67, p < 0.001). Additionally, these techniques significantly improved dynamic balance in various directions, including anterior (ANT), anteromedial (AMED), medial (MED), posteromedial (PMED), posterior (POST), posterolateral (PLAT), lateral (LAT), and anterolateral (ALAT) directions (p < 0.01). Furthermore, there was a significant reduction in physical disability (RMDQ-F(1, 38) = 1307, p < 0.001), among two-wheeler riders suffering from chronic LBP. Compared to MET, SMFR using foam rollers was found to be more effective in enhancing hamstring flexibility, improving balance, and decreasing disability level on the RMDQ after 4weeks.

Ankle dorsiflexion range of motion and hip abductor strength can predict Lower Quarter Y-Balance Test performance in healthy males

ObjectivesThe aim of the study was to assess whether strength and range of motion (ROM) of the hip and ankle are the factors determining performance in the Lower Quarter Y-Balance test (YBT-LQ). DesignCross-sectional study. Participants66 healthy males (age: 25.2±6.8 years) participated in this study. Main outcome measuresParticipants underwent assessments of ankle dorsiflexion (DF) ROM, hip internal rotation (IR) ROM, external rotation (ER) ROM and isometric strength of hip abductor (ABD), extensor (EXT) and external rotators (ERS) muscles together with YBT-LQ for both legs. A forward 2-steps multiple linear regression analysis was conducted to examine the relationship between the predictor variables and the criterion variable. ResultsAnkle DF ROM predicted anterior (ANT) reach (R2 = 0.49; R2 = 0.33; p < 0.001). The model with hip ABD strength and ankle DF ROM explained posteromedial (PM) reach variance for stance leg (R2 = 0.35; p < 0.001), while only hip ABD strength was included for kicking leg (R2 = 0.19; p = 0.007). The model with ankle DF ROM and hip ABD strength explained posterolateral (PL) reach for stance leg (R2 = 0.41; p < 0.001). Hip ABD was the only predictor for kicking leg PL reach (R2 = 0.15; p < 0.001). YBT-LQ composite score was explained by ankle DF ROM and hip ABD strength for both legs (R2 = 0.44; p < 0.001) and (R2 = 0.25; p = 0.002). ConclusionHip ABD strength and ankle DF ROM can determine performance in the YBT-LQ. Strength of hip EXT, ERS as well as ROM of hip IR and ER did not predict YBT-LQ performance.

Effect of gender, leg dominancy and body mass index on Y-balance performance among young healthy adults

This study investigated the influence of the sex, dominant leg and BMI on dynamic balance control of young adults (mean age; 20 ± 1.56) using the Y-balance test-lower quarter (YBT-LQ). This cross-sectional study included 218 participants (105 men and 103 women) who were recruited as a convenient sample of young, normal adults. The examination was implemented in one session, with three trials in each direction on each leg. The maximum reach distance of the three trials in each direction was used for statistical analysis. The reported reach distances were also normalized for each participant's leg length. Males' right leg values in the posteromedial (PM), posterolateral (PL), and composite directions were substantially longer than females' (p&lt;0.05), and no significant difference between both sexes in anterior (AT) direction (p&gt;0.05). In all directions, there were no significant differences between both sexes for the left leg (p&gt;0.05), and no significant differences between the right values of the dominant and non-dominant legs (p&gt;0.05). However, the left values of the non-dominant legs were longer than the dominant leg in directions (p&lt;0.05). The right leg values of the AT, PM, and composite values of the average BMI subjects was greater than the over-weight and obese subjects (p&lt;0.05), and the left leg values of the AT and composite values of the average BMI subjects was greater than over-weight and obese subjects (p&lt;0.05). Males have a longer right leg reach distance in the PM, PL directions, and composite value compared to females. The right leg dominant participants have longer reach distance of the left leg in all directions. When compared to over-weight and obese participants, average body weight subjects have bilaterally larger reach distance in the AT and composite directions.

The Effects of a Short Virtual Reality Training Program on Dynamic Balance in Tennis Players.

This study aimed to analyze the effects of a 5 min virtual reality training program (VR) on dynamic balance in tennis players. Fifty-eight college tennis players (mean age 22.9 ± 3.1 years, weight 73.9 ± 10.8 kg, height 176.6 ± 8.4 cm) were allocated to either the control group (placebo) (CG, n = 20) or the right-handed experimental group (RTG, n = 20) and left-handed experimental group (LTG, n = 18), both of which took part in the 5 min VR intervention program. Pre-tests included anthropometric measures and the Y Balance Test (YBT), and the post-test was the Y Balance Test (YBT). Three YBT trials were performed in anterior (ANT), posterolateral (PL), and posteromedial (PM) directions. After the training intervention, in the right-handed experimental group (RTG), significant differences were observed for two variables: anterior reach (right foot) (p = 0.00) and posterior medial reach (right foot) (p = 0.03). In other analyzed variables, there were no significant differences. Additionally, the effect size was small. In the left-handed experimental group (LTG), statistically significant improvements were identified in five out of six analyzed variables: anterior reach (left foot) (p = 0.00), posterior medial reach (left foot) (p = 0.00), posterior lateral reach (left foot) (p = 0.00), posterior medial reach (right foot) (p = 0.00), and posterior lateral reach (right foot) (p = 0.00). The effect size ranged between small and medium. No significant changes were observed in the control group (CG) after the training intervention. Moreover, for all variables, the time*group interaction is determined. Anterior reach (left foot), posterior medial reach (left foot), posterior medial reach (right foot), and posterior lateral reach (right foot) showed significant interactions (F = 3.04, p = 0.05; F = 3.50, p = 0.03; F = 6.08, p = 0.00; and F = 4.69, p = 0.01). The outcome of this study leads us to a further understanding that if a player were to partake in VR activity, it could show a positive effect on their dynamic balance performance.

Immediate effects of local muscle vibration on static and dynamic balance control in individuals with chronic ankle instability

ObjectivesTo investigate the immediate effects of local muscle vibration (LMV) on static and dynamic balance control in individuals with and without chronic ankle instability (CAI). DesignQuasi-experimental study. SettingResearch laboratory. ParticipantsTwenty-six individuals with CAI and 26 healthy controls. Main outcome measuresCenter of pressure variables (mean total velocity and displacement in anteroposterior (AP) and mediolateral (ML) directions) during single-leg standing with eyes open and eyes closed and also reach distances in anterior (ANT), posteromedial (PM), and posterolateral (PL) directions of the modified star excursion balance test (MSEBT) were assessed before and after LMV. ResultsStatistical analyses showed a significant decrease in mean total velocity and displacement in AP direction from before to after LMV in eyes open condition for both individuals with CAI (p = 0.025, p = 0.041, respectively) and healthy controls (p = 0.001, p = 0.003, respectively). Similar results were observed in eyes closed condition for both individuals with CAI (p < 0.001, p < 0.001, respectively) and healthy controls (p = 0.040, p = 0.014, respectively). The results also showed increased reach distances in ANT (p < 0.001), PM (p < 0.001), and PL directions (p < 0.001) in all participants after LMV. ConclusionOur results suggest that LMV may be a useful tool in rehabilitation of static and dynamic balance deficits in individuals with CAI.

837 Responsive Neurostimulation of the Thalamus for the Treatment of Refractory Epilepsy

INTRODUCTION: One-third of patients with epilepsy experience seizures despite antiepileptic medications. Some of these refractory patients may not be candidates for surgical resection. The Responsive Neurostimulation System (RNS) is a closed-loop device that uses programmable detection and stimulation. METHODS: We performed a prospective single-center study of consecutive refractory epilepsy patients who underwent RNS system implantation in the anterior (ANT) and centromedian (CM) thalamic nuclei from September 2015 to December 2020. Patients were followed postoperatively to evaluate seizure freedom and complications. RESULTS: Twenty-three patients underwent placement of 36 RNS thalamic leads (CM = 27 leads, ANT = 9 leads). Mean age at implant was 18.8 ± 11.2 years. Two patients (8.7%) developed infections: 1 improved with antibiotic treatments alone, and 1 required removal with eventual replacement of the system. Mean follow-up was 22.3 months. Based on overall reduction of seizure frequency, 2 patients (8.7%) had no- to &lt;25% improvement, 6 patients (26.1%) had 25-49% improvement, 14 patients (60.9%) had 50-99% improvement, and 1 patient (4.3%) became seizure-free. All patients reported significant improvement in seizure duration and severity, and 17 patients (74%) reported improved post-ictal state. There was a trend for subjects with foci located in the temporal lobe to achieve better outcomes after thalamic RNS compared to those with extratemporal foci. Seizure etiology was syndromic in 12 cases (52.2%). CONCLUSIONS: Thalamic RNS achieved ≥50% seizure control in ∼65% of patients. Infections were the most common complication. This therapeutic modality may be particularly useful for patients affected by aggressive epilepsy syndromes since a young age, those whose seizure foci are located in the mesial temporal lobe, and those who have failed prior surgical interventions.

Impact of polystyrene microplastic exposure on gilthead seabream (Sparus aurata Linnaeus, 1758): Differential inflammatory and immune response between anterior and posterior intestine

Plastics are the most widely discharged waste into the aquatic ecosystems, where they break down into microplastics (MPs) and nanoplastics (NPs). MPs are ingested by several marine organisms, including benthic and pelagic fish species, contributing to organ damage and bioaccumulation.This study aimed to assess the effects of MPs ingestion on gut innate immunity and barrier integrity in gilthead seabreams (Sparus aurataLinnaeus, 1758) fed for 21 days with a diet enriched with polystyrene (PS-MPs; 1–20 μm; 0, 25 or 250 mg /kg b.w./die).Physiological fish growth and health status were not impacted by PS-MPs treatments at the end of experimental period. Inflammation and immune alterations were revealed by molecular analyses in both anterior (AI) and posterior intestine (PI) and were confirmed by histological evaluation. PS-MPs triggered TLR-Myd88 signaling pathway with following impairment of cytokines release. Specifically, PS-MPs increased pro-inflammatory cytokines gene expression (i.e., IL-1β, IL-6 and COX-2) and decreased anti-inflammatory ones (i.e., IL-10). Moreover, PS-MPs also induced an increase in other immune-associated genes, such as Lys, CSF1R and ALP. TLR-Myd88 signaling pathway may also lead to the mitogen-activated protein kinases (MAPK) signaling pathway activation. Here, MAPK (i.e., p38 and ERK) were activated by PS-MPs in PI, following the disruption of intestinal epithelial integrity, as evidenced by reduced gene expression of tight junctions (i.e. ZO-1, Cldn15, Occludin, and Tricellulin), integrins (i.e., Itgb6) and mucins (i.e., Muc2-like and Muc13-like). Thus, all the obtained results suggest that the subchronic oral exposure to PS-MPs induces inflammatory and immune alterations as well as an impact on intestinal functional integrity in gilthead seabream, with a more evident effect in PI.

Subchronic Exposure to Polystyrene Microplastic Differently Affects Redox Balance in the Anterior and Posterior Intestine of Sparus aurata.

Microplastics (MPs) are pollutants widely distributed in aquatic ecosystems. MPs are introduced mainly by ingestion acting locally or in organs far from the gastroenteric tract. MPs-induced health consequences for fish species still need to be fully understood. We aimed to investigate the effects of the subchronic oral exposure to polystyrene microplastics (PS-MPs) (1-20 μm) in the gilthead seabreams (Sparus aurata) used as the experimental model. We studied the detrimental impact of PS-MPs (25 and 250 mg/kg b.w./day) on the redox balance and antioxidant status in the intestine using histological analysis and molecular techniques. The research goal was to examine the anterior (AI) and posterior intestine (PI) tracts, characterized by morphological and functional differences. PS-MPs caused an increase of reactive oxygen species and nitrosylated proteins in both tracts, as well as augmented malondialdehyde production in the PI. PS-MPs also differently affected gene expression of antioxidant enzymes (i.e., superoxide dismutase, catalase, glutathione reductase). Moreover, an increased up-regulation of protective heat shock proteins (HSPs) (i.e., hsp70 and hsp90) was observed in PI. Our findings demonstrate that PS-MPs are responsible for oxidative/nitrosative stress and alterations of detoxifying defense system responses with differences in AI and PI of gilthead seabreams.

The Effect of Leg Dominance and Group Difference in Star Excursion Balance Test between Individuals with Chronic Ankle Instability, Ankle Sprain Copers and Healthy Controls.

To evaluate patients with chronic ankle instability (CAI), copers who had a sprain without instability, and healthy controls using the Star Excursion Balance Test (SEBT). In addition, the reach distance was assessed between the both legs in terms of dominant and non-dominant in all groups. A total of 75 subjects (25 healthy, 25 CAI, and 25 Coper) participated. The maximum reach distance in SEBT was assessed in anterior (ANT), postero-medial (PM), and postero-lateral (PL) directions in both legs for each subject. All data were analyzed by SPSS version 21. Tukey post hoc test was used to compare all groups. Paired T-test was used to compare dominant and non-dominant legs in each group. In 75 subjects have participated in the data collection, no significant differences were reported among all groups for age and BMI measurements. Significant lower reach distance in scores of ANT in the dominant leg of the CAI was demonstrated when compared with the control and the coper groups (P=0.008). No statistical significant difference was determined between the dominant and non-dominant legs in each group (P>0.05). It seems that relevant strategies for postural control should be taken into account in the rehabilitation setup of individuals with CAI.

A comparison of veteran athletes and sedentary individuals in terms of dynamic-static balance and cognitive functions

There is strong evidence that being physically active has positive effects on healthy aging, primary and secondary prevention of the development of chronic diseases. The physical and cognitive health benefits of having an active past are less well-known. Therefore, this study aimed to compare veteran athletes with an active sports history with their sedentary peers in terms of balance and cognitive function. Fourteen veteran soccer players and 15 sedentary male volunteers aged between 35-55 years participated in the study. The demographic characteristics of the participants were questioned with a case report form. Participants' balance was evaluated statically and dynamically. Static balance was assessed using the Flamingo test and dynamic balance was assessed with the Y Balance test. The Montreal Cognitive Assessment (MoCA) was used to test cognitive functions. There was no difference between Veteran Athletes (VA) and Sedentary Participants (SP) in terms of static balance test scores with both right and left sides (p&gt;0.05). The results of the VA group were significantly higher (p&lt;0.05) in terms of the total scores of the Y balance test, which consisted of the average of the anterior (ANT), posterolateral (PL), and posteromedial (PM) reaches (p&lt;0.05). In terms of MoCA score, the VA group obtained significantly higher results compared to the SP group (p&lt;0.05). Veteran athletes were found to be superior to same-aged sedentary in terms of dynamic balance and cognitive function. Having an active sporting background can help to mitigate the loss of physical skills such as balance and cognitive functioning that inevitably occurs during the natural aging process. In addition, active old age is also crucial for the preservation of these skills.

Effects of fatigue on balance and ankle proprioception during drop landing among individuals with and without chronic ankle instability

This study aimed to explore the effects of fatigue on the balance and ankle proprioception during drop landing of individuals with chronic ankle instability (CAI). A total of 35 participants with unilateral CAI and 35 healthy participants participated in this study. A static balance test, dynamic balance test, and ankle proprioception test were conducted before and after fatigue. Fatigue was induced with turn back runs and vertical jumps protocol. Sway distance of the center of pressure (COP), root mean square of the COP (RMS), total excursions (TOTEX), mean velocity (MVELO), 95% confidence ellipse area of the COP movements (95% AREA), Normalise Reach Distance in the anterior (ANT), posteromedial (PM), and posterolateral (PL) directions, and the area under the curve (AUC) were calculated and analyzed. There were significant group by fatigue interactions for static balance variables, normalise reach distance in the PM and PL directions, and AUC. Fatigue reduced balance and ankle proprioception in individuals with CAI. After fatigue, static and dynamic balance and ankle proprioception during drop landing were significantly worse in the CAI group than in the control group. Fatigue had a significant negative effect on balance and ankle proprioception in CAI patients. Therefore, fatigue may be an important factor causing repeated ankle sprain in CAI patients.

Establishing Normative Dynamic Postural Control Values in Elite Female Handball Players.

BackgroundLower extremity injuries among young female handball players are very common. The modified Star Excursion Balance Test (mSEBT) is a valid clinical tool to assess dynamic postural control and identify athletes with higher risk of injury. However, its interpretation is difficult since performance on this test is highly sport dependent. No normative values on the mSEBT exist in handball.PurposeThe aim of this investigation was to establish normative ranges of mSEBT performance in young, healthy female handball players to help practitioners when interpreting risk estimates.Study designCross-Sectional StudyMethodsAthletes from 14 elite teams were recruited during a national tournament and performed 3 trials in the anterior (ANT), posteromedial (PM), posterolateral (PL) directions of the mSEBT. Means, standard deviations and 95% confidence intervals (95%CI) of normalized reached distances were calculated for each direction and the composite score (COMP). Level of asymmetry between dominant and non-dominant limbs were calculated for each direction using Bland Altman analyses. Group differences were weighed against the established mSEBT minimum detectable differences (MDD) to compare scores between limbs and across different player positions.ResultsOne-hundred and eighty-eight females (16.8±0.9 years) were tested. Mean reach distances were 65.2±5% (64.7-65.7), 110.0±6.2% (109.3-110.6), 107.1±6.2% (106.5-107.8) and 94.1±4.9% (93.6-94.6) for the ANT, PM, PL directions and COMP score respectively. Bias and limits of agreement for limb asymmetry were -0.23% (-5.85%, 5.38%) for ANT, -0.83% (-8.80%, 7.14%) for PM, 0.33% (-8.51%, 9.17%) for PL and -0.27% (-4.88%, 4.33%) for COMP score. No meaningful differences were observed between limbs or across player positions since the values did not exceed the MDD and all 95%CIs overlapped.ConclusionThis study provides normative performance values for dynamic postural control as measured by the mSEBT among young, healthy, elite female handball players. Considering the high incidence of injury in this population, these values can be used for injury risk reduction and return to sport decisions. Further prospective studies are needed to established specific cut-off scores in this population.Level of evidence2c

A Comparison Of Dynamic And Static Yoga Programs On Body Composition, Flexibility, And Balance

Essentrics is a dynamic full body stretch and strengthening workout that requires dynamic movements such as, but not limited to, ceiling reaches, side-to-side bends with lunges, and side leg lifts that may elicit improvements in body composition, flexibility, and balance. PURPOSE: To examine the benefits of 6-weeks long Essentrics (dynamic) program compared to standard (static) Yoga on body composition, flexibility, and balance. METHODS: Thirty-one participants (24 females and 7 males, age = 20.4 ± 0.2 yrs, and BMI = 22.58 ± 0.55 kg/m2) were assigned to two groups - a standard Yoga (YOG, n = 20) and an Essentrics (ESS, n = 11) group. Each group met 3 times per week for a total of 45-50 minutes per day for 6 weeks. Anthropometric measurements, body composition (dual-energy x-ray absorptiometry), flexibility (sit-and-reach), and balance (lower extremity Y-balance) were assessed before and after the 6-week program. Measurements of the balance test included 3 reaches and their combined values [anterior (ANT), posteromedial (PM), posterolateral (PL), and composite reach distance (CRD)]. All reaches were averaged for the right and left side and then normalized to leg length. Data were analyzed using an ANOVA with repeated measures (p < 0.05), and a post-hoc test was performed if any significant main or interaction effects were found. RESULTS: There were no significant differences in flexibility and balance between YOG and ESS groups. However, both groups improved their balance after 6-weeks of program; PM (87.13 ± 11.64 cm to 92.25 ± 9.91 cm, p = .001), PL (82.88 ± 11.28 to 88.62 ± 9.62 cm, p = .002), CRD (225.96 ± 27.17 to 238.26 ± 22.98 cm, p = .001), normalized PM (98.31 ± 11.68 to 104.27 ± 11.14%, p = .001), normalized PL (93.60 ± 11.98 to 100.15 ± 10.70%, p = .001), and normalized CRD (255.12 ± 27.89 to 269.21 ± 25.07%, p = .001). Additionally, the flexibility improved (51.42 ± 8.24 to 53.38 ± 7.04 cm, p = .010) after 6-weeks of program. Interestingly, total body fat percentage was significantly reduced only in the YOG group (24.44 ± 6.73 to 23.51 ± 6.32%, p = .002). CONCLUSION: Regardless of the type of yoga program followed (static vs. dynamic), both improved flexibility and balance. Individuals seeking to improve balance and/or flexibility can benefit from either program.

CORE VS PLYOMETRIC TRAINING EFFECTS ON DYNAMIC BALANCE IN YOUNG MALE SOCCER PLAYERS

ABSTRACT Introduction: Today, different types and volumes of strength training are used to increase the performance of athletes. However, the effect of this training on dynamic balance in young soccer players is a matter of curiosity. Objective: The purpose of this study is to determine the effects of core and plyometric training on dynamic balance in young male soccer players. Materials and Methods: Eighteen male soccer players between 17 and 18 years of age participated in the study voluntarily. Subjects were randomly separated into three groups: core training group (C, n=6), plyometric training group (P, n=6), and control group (Con, n=6). Group C and P subjects participated in the determined training programs, in addition to soccer training, two days a week for eight weeks. The Con group only continued their soccer training. The Y-balance test (before and after eight weeks) was applied to determine the balance performance of the subjects. Results: After eight weeks of core training, significant differences in anterior (ANT) and posteromedial (PM) balance performance on the dominant side and in ANT, PM, and posterolateral (PL) balance performance on the non-dominant side were observed in group C subjects. The PL and PM balance performance of group P subjects after plyometric training was found to be significantly different on both sides. Conclusion: As a result, it was determined that applying core and plyometric training in addition to soccer training increases dynamic balance. We recommend that trainers and coaches use core and plyometric exercises in their training, as these programs will provide a positive performance increase in balance and gains in muscle strength. Level of Evidence III; Prospective comparative study.

Mapping of corneal birefringence in thin and asymmetric keratoconus corneas with ultrahigh-resolution polarization-sensitive OCT.

To evaluate phase retardation (PR) across healthy eyes and eyes with thin corneas (<500 μm) and with asymmetric and bilateral keratoconus (KC). Narayana Nethralaya Eye Hospital, Bangalore, India. Observational cross-sectional. There were 4 eye groups: healthy eyes (Group 1; n = 10 eyes), eyes with thin corneas and no clinical disease (Group 2; n = 10 eyes), eyes with asymmetric KC (Group 3; n = 5 eyes), and eyes with clinical KC (Group 4; n = 15 eyes). All eyes were imaged with polarization-sensitive optical coherence tomography (PS-OCT), MS-39, and Corvis-ST. Using PS-OCT, PR was analyzed in annular regions. The anterior (A-E) and Bowman (E-B) wavefront aberrations, epithelial Zernike indices (EZI), total corneal thickness, Corvis biomechanical index (CBI), total biomechanical index (TBI), and Belin-Ambrósio overall deviation index (BAD-D) were analyzed. Only CBI, TBI, BAD-D, A-E and E-B aberrations, EZI, and total corneal thickness distributions of Groups 1 (n =10), 2 (n =10), and 3 (n =5) were similar ( P > .05) but not CCT ( P < .05). PR distributions clearly showed that the eyes in Groups 1, 2, and 3 had a normal corneal birefringence unlike Group 4 (n = 10) eyes ( P < .05). The PR map was similar to the preferred orientations of collagen fibers seen in X-ray diffraction ex vivo studies of corneal stroma. PR distributions may eliminate the uncertainty associated with the stromal status of thin and asymmetric KC corneas. Group 2 and 3 eyes appeared as healthy because of normal corneal birefringence at the time of imaging, but a longitudinal follow-up of these eyes with PS-OCT may assist in early detection of onset of disease.

Responsive Neurostimulation of the Thalamus for the Treatment of Refractory Epilepsy.

IntroductionOne-third of patients with epilepsy continue to have seizures despite antiepileptic medications. Some of these refractory patients may not be candidates for surgical resection primarily because the seizure onset zones (SOZs) involve both hemispheres or are located in eloquent areas. The NeuroPace Responsive Neurostimulation System (RNS) is a closed-loop device that uses programmable detection and stimulation to tailor therapy to a patient's individual neurophysiology. Here, we present our single-center experience with the use of RNS in thalamic nuclei to provide long-term seizure control in patients with refractory epilepsy.MethodsWe performed a prospective single-center study of consecutive refractory epilepsy patients who underwent RNS system implantation in the anterior (ANT) and centromedian (CM) thalamic nuclei from September 2015 to December 2020. Patients were followed postoperatively to evaluate seizure freedom and complications.ResultsTwenty-three patients underwent placement of 36 RNS thalamic leads (CM = 27 leads, ANT = 9 leads). Mean age at implant was 18.8 ± 11.2 years (range 7.8–62 years-old). Two patients (8.7%) developed infections: 1 improved with antibiotic treatments alone, and 1 required removal with eventual replacement of the system to recover the therapeutic benefit. Mean time from RNS implantation to last follow-up was 22.3 months. Based on overall reduction of seizure frequency, 2 patients (8.7%) had no- to <25% improvement, 6 patients (26.1%) had 25–49% improvement, 14 patients (60.9%) had 50–99% improvement, and 1 patient (4.3%) became seizure-free. All patients reported significant improvement in seizure duration and severity, and 17 patients (74%) reported improved post-ictal state. There was a trend for subjects with SOZs located in the temporal lobe to achieve better outcomes after thalamic RNS compared to those with extratemporal SOZs. Of note, seizure etiology was syndromic in 12 cases (52.2%), and 7 patients (30.4%) had undergone resection/disconnection surgery prior to thalamic RNS therapy.ConclusionThalamic RNS achieved ≥50% seizure control in ~65% of patients. Infections were the most common complication. This therapeutic modality may be particularly useful for patients affected by aggressive epilepsy syndromes since a young age, those whose seizure foci are located in the mesial temporal lobe, and those who have failed prior surgical interventions.

Dynamics of keratoconus progression after a previous successful accelerated crosslinking treatment during and after pregnancy.

To evaluate the effectiveness of previously applied successful accelerated corneal crosslinking (CXL) treatment in keratoconus stabilization during and after pregnancy. Ankara Yildirim Beyazit University, Ataturk Training and Research Hospital, Turkey. Prospective clinical study. Patients with stable keratoconus (after having an accelerated CXL procedure) who became pregnant were included. Uncorrected (UDVA) and corrected distance visual acuity (CDVA), manifest astigmatism (MA), keratometry (K)1, K2, Kmax, central corneal thickness (CCT), thinnest corneal thickness (TCT), and anterior (AE) and posterior elevation (PE) were recorded at baseline (before CXL), before pregnancy (the last visit after CXL), during pregnancy (third trimester), and after pregnancy (the last visit after pregnancy). 24 eyes of 19 patients were included. The mean time between CXL and conception was 12.4 ± 5.1 months. The mean postpartum follow-up period was 27.6 ± 13.3 months. The mean UDVA, CDVA, MA, and PE values did not show any statistically significant differences during and after pregnancy compared with the post-CXL values (P > .05). The mean Kmax flattened significantly after the CXL procedure (P = .011); however, it increased during pregnancy (P = .037, after CXL vs pregnancy) and then decreased back to the prepregnancy level after pregnancy (P = .035, pregnancy vs after pregnancy). The mean K1, K2, AE, CCT, and TCT remained stable during pregnancy and significantly decreased after pregnancy (P < .05). Keratoconus seems to progress during pregnancy in corneas that have previously received successful accelerated CXL treatment. However, this progress was mostly temporary, and generally, regression occurred after delivery.

Exploring the Y-Balance-Test scores and inter-limb asymmetry in soccer players: differences between competitive level and field positions

BackgroundThe postural stability seems to be important in the physical development of the soccer player and the specific tasks related to the game. In addition, it is related to the injury risk and therefore, with the injury prevention and retraining processes. In this context, the Y Balance Test (YBT) is presented as a tool to assess dynamic postural control.ObjectiveThis study aimed to explore the differences and possible correlations in the YBT scores and inter-limb asymmetry for anterior (ANT), posteromedial (PM) and posterolateral (PL) directions by category and field position in soccer players.Methods173 males soccer players aged between 14 and 33 years old agreed to participate. Five categories and six field position were considered in this study. A standardised protocol was used at multiple clubs during the pre-season assessment of musculoskeletal function in soccer players. All the players performed the Y Balance Test (YBT) (official YBT Kit), assessing the dominant and non-dominant leg for three YBT directions (anterior-AN, posteromedial-PM and posterolateral-PL), inter-limb asymmetry and composite score.ResultsFor AN, amateur and semiprofessional obtained the highest values for Dominant and Non-Dominant legs (Rangemean = 101.8–109.4%) and the lowest level in PRO players (mean: 62.0%). Concerning PM-PL, semiprofessional (Rangemean = 126.4–132.7%, dominant and non-Dominant respectively), followed by professional and amateur reported higher scores compared to youth categories. Inter-limb asymmetry showed higher values in lower age categories. The best composite scores were detected in semiprofessionals (Rangemean = 113.3–126.7% for dominant and Rangemean = 113.8–129.7% for non-Dominant leg), compared with the rest of the categories and for each field position evaluated.ConclusionComparisons between field-positions revealed that centre-backs were worse than wingers and forwards. In order to explain variations in dynamic balance between competitive levels within the same age-group, special considerations about training programmes and related co-variables should be considered.

Intestinal microbiota analysis and probiotic application in gamat sea cucumber ( Stichopus horrens )

Gamat sea cucumber (Stichopus horrens) is an commercially valuable sea cucumber that is rich in nutritional values and pharmacological properties. This study aimed to explore the microbiota in the intestinal tract of S. horrens using high-throughput sequencing, based on the 16S rRNA gene sequences. Proteobacteria was found to be predominant phylum. Vibrio was the top genus in the anterior (AI) and the posterior (PI) parts of the intestine of S. horrens, while some genera were different between two parts. These results suggested that the bacteria in the AI were associated with fermentation and bile acid biosynthesis processes, while those in the PI functioned as helper cells in digestion processes in the host. In this study, Firmicutes phylum of lactic acid bacteria was found, so the probiotic bacteria were selected for sea cucumber aquaculture application. We found Pediococcus pentosaceus strain SH1 grew well at a wide range of pH and high NaCl concentrations, which was suitable for survival in seawater. In feeding trial study, P. pentosaceus SH1 significantly (p < 0.05) increased the survival rate of larvae in the first period (Day 4) of larvae culture and also improved water quality by converting total ammonia nitrogen to nitrite and reducing nitrate levels in the water system. In conclusion, P. pentosaceus SH1 has the potential to increase the survival rate of larvae and improve water quality in sea cucumber aquaculture.