Lateral Excursion Research Articles

Left Ventricular Diastolic and Systolic Functions in Patients with Hypothyroidism.

Background and objectives: Long standing hypothyroidism may impair myocardial relaxation, but its effect on systolic myocardial function is still controversial. The aim of this study was to investigate left ventricular (LV) systolic and diastolic function in patients with hypothyroidism. Materials and Methods: This study included 81 (age 42 ± 13 years, 92% female) patients with hypothyroidism, and 22 age and gender matched controls. All subjects underwent a detailed clinical examination followed by a complete biochemical blood analysis including thyroid function assessment and anthropometric parameters measurements. LV function was assessed by 2-dimensional, M-mode and Tissue-Doppler Doppler echocardiographic examination performed in the same day. Results: Patients had lower waist/hip ratio (p< 0.001), higher urea level (p = 0.002), and lower white blood cells (p = 0.011), compared with controls. All other clinical, biochemical, and anthropometric data did not differ between the two groups. Patients had impaired LV diastolic function (lower E wave [p< 0.001], higher A wave [p = 0.028], lower E/A ratio [p< 0.001], longer E wave deceleration time [p = 0.01], and higher E/e’ ratio [p< 0.001]), compared with controls. Although LV global systolic function did not differ between groups, LV longitudinal systolic function was compromised in patients (lateral mitral annular plane systolic excursion—MAPSE [p = 0.005], as were lateral and septal s’ [p< 0.001 for both]). Conclusions: In patients with hypothyroidism, in addition to compromised LV diastolic function, LV longitudinal systolic function is also impaired compared to healthy subjects of the same age and gender. These findings suggest significant subendocardial function impairment, reflecting potentially micro-circulation disease that requires optimum management.

Echocardiographic evaluation of left ventricular systolic function by the M-mode lateral mitral annular plane systolic excursion in patients with Duchenne muscular dystrophy age 0-21 years.

Background and AimsDuchenne muscular dystrophy (DMD) results in cardiac fibrosis and dysfunction. These patients frequently have poor image quality. Mitral annular plane systolic excursion (MAPSE) is a reproducible and reliable method for determining function and can be a valuable tool in patients with poor images. Our study was performed to evaluate the feasibility of MAPSE and compare it to shortening fraction (SF) in patients with DMD.MethodsLateral M‐mode MAPSE was obtained on all echocardiograms performed on DMD patients aged 0 to 21 years between October 2013 and April 2015. Retrospectively, interobserver and intraobserver variability was determined for these measurements and each measurement was compared to patient characteristics and measured values of SF.ResultsThere was good interobserver (r 2 = .66, P = .0081) correlation. Seventeen of 59 echocardiograms (29%) had abnormal SF while 32 (54%) echocardiograms had an abnormal M‐mode lateral MAPSE Z‐score. There was no significant association between lateral MAPSE Z‐score and SF. Age at the time of echocardiogram and time from diagnosis to echocardiogram both had a significant negative correlation with lateral MAPSE.ConclusionsLateral M‐mode MAPSE measurements are reproducible in young patients with Duchenne muscular dystrophy. M‐mode lateral MAPSE may worsen over length of time with Duchenne muscular dystrophy. Further studies are necessary to provide absolute conclusions, but this study shows that lateral M‐mode MAPSE may be a valuable additional tool at routine echocardiogram in these patients.

Occupant Restraint in Far-Side Impacts: Cadaveric and WorldSID Responses to a Far-Side Airbag

Previous studies indicate that seatbelts may require supplementary restraints to increase their effectiveness in far-side impacts. This study aimed to evaluate the effectiveness of a novel, far-side-specific airbag in restraining and preventing injuries in far-side impacts, and to evaluate the WorldSID's response to the presence of a far-side airbag. A series of tests with three Post-Mortem Human Subjects and the WorldSID was conducted in a vehicle-based sled environment equipped with a far-side airbag. Results of these tests were evaluated and compared to a previous test series conducted without the airbag. All of the PMHS retained the shoulder belt on the shoulder. The airbag significantly reduced PMHS injury severity and maximum lateral head excursion. While the WorldSID exhibited a similar decrease in lateral excursion, it was unable to represent PMHS thoracic deflection or injury probability, and it consistently slipped out of the shoulder belt. This indicates that the WorldSID is limited both in its ability to evaluate the effect of changes in the seatbelt system and in its ability to predict thoracic injury risk and assess airbag-related injury mitigation countermeasures.

Maximum mandibular mobility in patients with temporomandibular disorders.

Assessment of mandibular mobility is an integral part of many dental examinations. Yet, information on the maximum range of mandibular motion in large groups of patients with temporomandibular disorders (TMDs) is limited. Therefore, we analyzed the corresponding data of 500 TMD patients who had presented at the University Center for Dental Medicine Basel. All measurements had been carried out by one examiner. The average maximal values for unassisted jaw opening, protrusion, and movement to the right and left were 49.3 mm (SD: 9.1), 8.8 mm (SD: 2.3), 9.4 mm (SD: 2.5), and 11.8 mm (SD: 3.1), respectively. Since activities such as chewing, talking, oral hygiene or even yawning require neither very wide openings nor extensive lateral or protrusive excursions, we would like to propose the following general threshold values for impaired mandibular function: maximum interincisal distance < 30 mm; maximum laterotrusion as well as maximum protrusion < 5 mm. These cut-off values, which are lower than those traditionally suggested in the dental literature, appear to be sufficient to carry out functionally undisturbed mandibular movements. By lowering the traditionally higher thresholds, the spectrum of anatomical and functional variability is increased. In this way, patients and non-patients may be protected against medicalization, overdiagnosis, and overtreatment.

Maximum mandibular mobility in patients with temporomandibular disorders.

Assessment of mandibular mobility is an integral part of many dental examinations. Yet, information on the maximum range of mandibular motion in large groups of patients with temporomandibular disorders (TMDs) is limited. Therefore, we analyzed the corresponding data of 500 TMD patients who had presented at the University Center for Dental Medicine Basel. All measurements had been carried out by one examiner. The average maximal values for unassisted jaw opening, protrusion, and movement to the right and left were 49.3 mm (SD: 9.1), 8.8 mm (SD: 2.3), 9.4 mm (SD: 2.5), and 11.8 mm (SD: 3.1), respectively. Since activities such as chewing, talking, oral hygiene or even yawning require neither very wide openings nor extensive lateral or protrusive excursions, we would like to propose the following general threshold values for impaired mandibular function: maximum interincisal distance < 30 mm; maximum laterotrusion as well as maximum protrusion < 5 mm. These cut-off values, which are lower than those traditionally suggested in the dental literature, appear to be sufficient to carry out functionally undisturbed mandibular movements. By lowering the traditionally higher thresholds, the spectrum of anatomical and functional variability is increased. In this way, patients and non-patients may be protected against medicalization, overdiagnosis, and overtreatment.

Contact kinematics of patient-specific instrumentation versus conventional instrumentation for total knee arthroplasty

BackgroundThe goal was to evaluate the joint contact kinematics of total knee arthroplasties implanted using patient-specific instrumentation (PSI) compared to conventional instrumentation (CI). We hypothesized that use of PSI would not significantly alter contact kinematics. MethodsThe study was a prospective randomized controlled trial, with equal allocation of fifty patients to PSI and CI groups. At two years post-operation, patients underwent weight-bearing stereo X-ray examinations at 0°, 20°, 40°, 60°, 80°, and 100° of flexion. The shortest tibiofemoral distance on each condyle determined the contact location. Magnitude of the shortest distance was measured and condylar separation was analyzed using thresholds of 0.5 and 0.75 mm. Kinematic measurements derived from the shortest distance included anteroposterior (AP) translation, excursion, axial rotation, and paradoxical anterior motion. Pivot position and cam/post contact were also investigated. ResultsThere were no differences (p > 0.05) in medial and lateral AP contact locations, excursions, and magnitude of anterior motion, or in axial rotation, pivot patterns, frequency of cam/post engagement, frequency of medial anterior motion, and condylar separation at a 0.75 mm threshold. Significant differences were found in frequency of lateral anterior motion (p = 0.048) and condylar separation at a 0.5 mm threshold (p = 0.010). Both groups displayed typical kinematics for a fixed-bearing posterior-stabilized implant. ConclusionsWe found no major differences in knee kinematics between PSI and CI groups, which suggest that PSI does not provide a significant kinematic advantage over conventional instruments.

Mitral Annular Plane Systolic Excursion: An Early Marker of Mortality in Severe COVID-19

Mitral Annular Plane Systolic Excursion: An Early Marker of Mortality in Severe COVID-19

DEVELOPMENT OF AN IN VIVO ULTRASOUND PROTOCOL TO STUDY THE MUSCULOAPONEUROTIC ARCHITECTURE OF THE MASSETER DURING MANDIBULAR PROTRUSION AND LATERAL EXCURSION

Background Temporomandibular disorders (TMDs) affect 5% to 12% of the population and lead to disability and pain. It has been suggested that architectural changes occur in the masseter muscle (MM) in TMDs. However, studies on normal in vivo MM architecture are scarce. Previously, our laboratory examined MM architectural changes during maximum intercuspation. Objective This work is an extension of our earlier studies in that it incorporates border jaw movements. It is hypothesized that a prototype in vivo ultrasonography protocol that will detect MM architectural changes during mandibular protrusion and lateral excursion can be developed. Materials and Methods The study was on the development of a prototype in vivo ultrasonography protocol based on cadaveric data. Results A protocol was successfully developed by identifying optimal probe positions and sites to visualize the MM laminae in mandibular protrusion and lateral excursion. The development involved correlation of anatomic specimens with in vivo ultrasonography, which enabled quantification and comparison of fiber bundle length, muscle thickness, and aponeurotic height. Discussion A novel ultrasonography protocol that will facilitate better understanding of normal MM morphology during mandibular protrusion and lateral excursion was developed. In the future, this protocol could be used as a basis to study MM changes in TMDs. Temporomandibular disorders (TMDs) affect 5% to 12% of the population and lead to disability and pain. It has been suggested that architectural changes occur in the masseter muscle (MM) in TMDs. However, studies on normal in vivo MM architecture are scarce. Previously, our laboratory examined MM architectural changes during maximum intercuspation. This work is an extension of our earlier studies in that it incorporates border jaw movements. It is hypothesized that a prototype in vivo ultrasonography protocol that will detect MM architectural changes during mandibular protrusion and lateral excursion can be developed. The study was on the development of a prototype in vivo ultrasonography protocol based on cadaveric data. A protocol was successfully developed by identifying optimal probe positions and sites to visualize the MM laminae in mandibular protrusion and lateral excursion. The development involved correlation of anatomic specimens with in vivo ultrasonography, which enabled quantification and comparison of fiber bundle length, muscle thickness, and aponeurotic height. A novel ultrasonography protocol that will facilitate better understanding of normal MM morphology during mandibular protrusion and lateral excursion was developed. In the future, this protocol could be used as a basis to study MM changes in TMDs.

Does Repositioning of Temporomandibular Joint Disc With Bone Anchors Provide Better Clinical Outcomes Than Conventional Disc Plication Procedures for Anterior Disc Displacements Without Reduction in Patients Refractory to Nonsurgical Treatments?

Although open temporomandibular joint arthroplasty with discopexy is a common treatment for patients with anterior disc displacements without reduction (ADDWo) unresponsive to medical management, there are no studies comparing disc repositioning with bone anchors and conventional discopexy procedure. The purpose of the study was to compare the efficacy between disc repositioning with bone anchors and the conventional discopexy procedure for ADDWo of temporomandibular joint refractory to medical management. A randomized controlled trial was conducted in patients with ADDWo. The primary objective was to compare the improvement in mouth opening (primary outcome variable) between the 2 treatment (primary predictor variable) groups-disc repositioning with bone anchors versus conventional disc plication. Secondary outcome variables were pain measured by visual analog scale, lateral excursions, and position of the disc evaluated by magnetic resonance imaging (MRI). Other variables of interest were age, gender, and duration of symptoms. The parameters were evaluated at preoperative, postoperative day 1, and 1-, 6-, and 12-month postoperative period. Categorical variables were compared with χ2 test and continuous variables with analysis of variance and adjusted for multiple comparisons with Bonferroni test. The study sample comprised 14 patients (7 in each group) with MRI-proven ADDWo. Statistically significant differences were found in the improvement of mouth opening between the 2 groups, showing better improvement with bone anchors (14.42±5.96 vs 7.57±7.25mm; P<.05). The reduction in visual analog scale also showed statistically significant difference with better pain reduction achieved with bone anchor (4.57±1.61 vs 3.28±0.75; P<.05). There was no statistically significant difference in lateral excursions and postoperative position of the disc evaluated by MRI between the groups at the 12-month follow-up period. Disc repositioning with bone anchors provides better clinical outcomes in terms of maximal mouth opening and pain scores compared with conventional disc plication.

Quality of life patients after treatment of mandibular fractures with ORIF in oral surgery departement of Dr. Sardjito general hospital

Management of mandibular fracture using open reduction Internal fixation (ORIF) method is one of the ideal treatments for single and multiple mandibular fractures. The aim of this study was to determine the quality of life of patients after the treatment of mandibular fractures with ORIF using miniplate in single and multiple mandibular fractures. This research used case-control by recalling 43 research subjects in the oral surgery department Dr Sardjito general hospital between 2013 and 2017, that consisted of patients suffering from 23 single fractures and 20 multiple mandibular fractures. Each fracture would be examined clinically and subjectively. Clinical examination parameters were conducted using the mandibular mobility index (MMI) consisting of mouth opening assessment, left and right lateral mandibular excursion, and mandibular protrusive movement. Subjective parameters were performed based on general oral health asseesment index (GOHAI) questionnaire to assess physiological aspects, psychosocial aspects, and pain. The results of the chi-square test statistic study showed that the quality of life of a patient with a single mandibular fracture was better than that of multiple mandibular fractures based on MMI and GOHAI examinations. It was concluded that patients with a single mandibular fracture had a younger age, longer time adaptation and have a better quality of life.

Single ventricle systolic function and cardiopulmonary exercise performance in adult patients with Fontan circulation

ObjectiveWe employed echocardiographic tissue characterization for the assessment of single ventricle systolic function and examined its relationship with cardiopulmonary exercise testing (CPET) performance in the Fontan circulation. Methods40 consecutive adult Fontan patients (16 female, 24 male; mean age 26.3 ± 5.9) were enrolled in our prospective cross-sectional study. All patients underwent echocardiographic assessment including tissue characterization and CPET within 3 days from each other. ResultsLAPSE (lateral annular plane systolic excursion) was higher in patients with a dominant left ventricle compared to a dominant right ventricle (12.3 + −2.6 vs 9.8 + −1.1 mm, p = .008) and in patients with AP (right atrium-pulmonary artery) connection than with lateral tunnel or extracardiac conduits (13.9 ± 1.7 vs 11.3 ± 2.6 and 10.9 ± 2.2 mm, p = .014 and p = .014, respectively). Maximal oxygen pulse (O2 pulse max) was significantly higher in patients with a dominant left or common ventricle compared to patients with a dominant right ventricle (10.3 and 12.0 vs 6.6 ml/beat, p = .002 and p = .032, respectively). There was a positive correlation between O2 pulse max and LAPSE (r = 0.442, p = .009), atrioventricular valve annulus systolic velocity (S′) (r = 0.606, p < .0001), lateral wall basal segment systolic velocity (bas vel s) (r = 0.469, p = .009) and lateral wall mid segment systolic velocity (mid vel s) (r = 0.452, p = .012). In the multivariable regression model, S′ (r = 0.606, p < .0001) remained predictive of O2 pulse max. ConclusionsLAPSE and S′ are suitable parameters for the assessment of systolic function in Fontan patients. Subclinical systolic dysfunction of longitudinal fibers is associated with worse CPET performance. O2 pulse max seems to be the best parameter reflecting Fontan patients' physical performance.

Comparison of Patellofemoral Kinematics and Stability After Medial Patellofemoral Ligament and Medial Quadriceps Tendon–Femoral Ligament Reconstruction

Background: There is a lack of evidence regarding the optimum extensor-sided fixation method for medial patellofemoral ligament (MPFL) reconstruction. There is increased interest in avoiding patellar drilling via soft tissue–only fixation to the distal quadriceps, thus reconstructing the medial quadriceps tendon–femoral ligament (MQTFL). The biomechanical implications of differing extensor-sided fixation constructs remain unknown. Hypothesis: The null hypothesis was there would be no differences between traditional MPFL reconstruction and MQTFL reconstruction with respect to resistance to lateral translation, patellar position, or patellofemoral contact pressures. Study Design: Controlled laboratory study. Methods: Nine adult knee specimens were mounted on a jig that applied static, physiologic loads to the quadriceps tendons. Patellar position and orientation, knee flexion angle, and patellofemoral pressure were recorded at 8 different flexion angles between 0° and 110°. Additionally, a lateral patellar excursion test was conducted wherein a load was applied directly to the patella in the lateral direction with the knee at 30° of flexion and subjected to 2-N quadriceps loads. Testing was conducted under 4 conditions: intact, transected MPFL, MQTFL reconstruction, and MPFL reconstruction. For MQTFL reconstruction, the surgical technique established by Fulkerson was employed. For MPFL reconstruction, a traditional technique was utilized. Results: The patellar excursion test showed no significant difference between the MQTFL and intact states with respect to lateral translation. MPFL reconstruction led to significantly less lateral translation (P < .05) than all other states. There were no significant differences between MPFL and MQTFL reconstructions with respect to peak patellofemoral contact pressure. MPFL and MQTFL reconstructions both resulted in increased internal rotation of the patella with the knee in full extension. Conclusion: Soft tissue-only extensor-sided fixation to the distal quadriceps (MQTFL) during patella stabilization appears to re-create native stability in this time 0 cadaver model. Fixation to the patella (MPFL) was associated with increased resistance to lateral translation. Clinical Relevance: Evolving anatomic knowledge and concern for patellar fracture has led to increased interest in MQTFL reconstruction. Both MQTFL and MPFL reconstructions restored patellofemoral stability to lateral translation without increasing contact pressures under appropriate graft tensioning, with MQTFL more closely restoring native resistance to lateral translation at the time of surgery.

Will Closed Treatment Provide Better Mandibular Motion Than Open Reduction and Internal Fixation in Cases of Unilateral Displaced Subcondylar Fracture? A Systematic Review and Meta-Analysis

The aim of the present systematic review was to determine whether closed treatment (CLT) with intermaxillary fixation (IMF) is superior or equivalent to open reduction and internal fixation (ORIF) in the management of unilateral displaced subcondylar fractures regarding the range of mandibular motion. To address our question, we conducted a systematic review and meta-analysis of the reported data after a comprehensive manual and electronic database search of studies reported up to 2017 in the English language that had compared CLT and ORIF of mandibular condyle fractures in adults. The following outcomes were recorded: maximum interincisal opening (MIO), protrusive movement (PM), lateral excursion toward the fractured side (LEFS), and lateral excursion toward the nonfractured side (LENFS). The search resulted in 8 studies, 4 of which were included in the meta-analysis. The MIO and PM showed no statistically significant differences, with an effect size of -0.823 (P=.112) and -0.633 (P=.079), respectively. However, the LEFS and LENFS were superior after CLT, with an effect size of -0.710 (P=.031) and -0.682 (P=.017), respectively. The findings from the present review suggest that both ORIF and CLT can provide comparable MIO and PM in subjects with unilateral displaced subcondylar fractures. However, CLT was superior to ORIF for both LEFS and LENFS.

Walking With Ears: Altered Auditory Feedback Impacts Gait Step Length in Older Adults.

Auditory feedback may provide the nervous system with valuable temporal (e. g., footstep sounds) and spatial (e.g., external reference sounds) information that can assist in the control of upright walking. As such, hearing loss may directly contribute to declines in mobility among older adults. Our purpose was to examine the impact of auditory feedback on the control of walking in older adults. Twenty older adults (65–86 years) with no diagnosed hearing loss walked on a treadmill for three sound conditions: Baseline, Ear Plugs, and White Noise. We hypothesized that in response to reduced temporal auditory feedback during the Ear Plugs and White Noise conditions, participants would adapt shorter and faster steps that are traditionally believed to increase mechanical stability. This hypothesis was not supported. Interestingly, we observed increases in step length (p = 0.047) and step time (p = 0.026) during the Ear Plugs condition vs. Baseline. Taking longer steps during the Ear Plugs condition may have increased ground reaction forces, thus allowing participants to sense footsteps via an occlusion effect. As a follow-up, we performed a Pearson's correlation relating the step length increase during the Ear Plugs condition to participants' scores on a clinical walking balance test, the Functional Gait Assessment. We found a moderate negative relationship (rho = −0.44, p = 0.055), indicating that participants with worse balance made the greatest increases in step length during the Ear Plugs condition. This trend suggests that participants may have actively sought auditory feedback with longer steps, sacrificing a more mechanically stable stepping pattern. We also hypothesized that reduced spatial localization feedback during the Ear Plugs and White Noise conditions would decrease control of center of mass (COM) dynamics, resulting in an increase in lateral COM excursion, lateral margin of stability, and maximum Lyapunov exponent. However, we found no main effects of auditory feedback on these metrics (p = 0.580, p = 0.896, and p = 0.056, respectively). Overall, these results suggest that during a steady-state walking task, healthy older adults can maintain walking control without auditory feedback. However, increases in step length observed during the Ear Plugs condition suggest that temporal auditory cues provide locomotor feedback that becomes increasingly valuable as balance deteriorates with age.

PMHS and WorldSID Kinematic and Injury Response in Far-Side Events in a Vehicle-Based Test Environment.

Far-side kinematics and injury are influenced by the occupant environment. The goal of the present study was to evaluate in-vehicle human far-side kinematics, kinetics and injury and to assess the ability of the WorldSID to represent them. A series of tests with five Post-Mortem Human Subjects and the WorldSID were conducted in a vehicle-based sled test environment. The surrogates were subjected to a far-side pulse of 16.5 g in a 75-degree impact direction. The PMHS were instrumented with 6 degree-of-freedom sensors to the head, spine and pelvis, a chestband, strain gauge rosettes, a 3D tracking array mounted to the head and multiple single 3D tracking markers on the rest of the body. The WorldSID lateral head excursion was consistent with the PMHS. However, forward head excursion did not follow a PMHS-like trajectory after the point of maximum lateral excursion. All but one PMHS retained the shoulder belt on the shoulder during the entire test. However, the WorldSID consistently slipped out of the shoulder belt. The PMHS sustained an average of five rib fractures for which the seatbelt was observed to be the largest contributor. The WorldSID showed a maximum rib deflection of 25 mm. The first rib fracture occurred no later than 50 ms into the event. Anatomical differences between the WorldSID and the PMHS rib cage prevented the WorldSID from capturing the injury mechanisms related to interactions of the occupant with the seatbelt and the seat.

Biofidelic Evaluation of the Large Omni-Directional Child Anthropomorphic Test Device in Low Speed Loading Conditions.

Motor vehicle crashes remain the leading cause of death for children. Traditionally, restraint design has focused on the crash phase of the impact with an optimally seated occupant. In order to optimize restrain design for real-world scenarios, research has recently expanded its focus to non-traditional loading conditions including pre-crash positioning and lower speed impacts. The goal of this study was to evaluate the biofidelity of the large omni-directional child (LODC) ATD in non-traditional loading conditions by comparing its response to pediatric volunteer data in low-speed sled tests. Low-speed (2-4 g, 1.9-3.0 m/s) frontal (0°), far-side oblique (60°), and far-side lateral (90º) sled tests, as well as lateral swerving (0.72 g, 0.5 Hz) tests, were conducted using the LODC. The LODC was restrained using a 3-point-belt with an electromechanical motorized seat belt retractor, or pre-pretensioner. Motion capture markers were placed on the head, torso, and belt. The LODC was compared to previously collected pediatric volunteer data as well as the HIII 10 and Q10. Significant difference between the pediatric volunteers and ATDs were identified by comparing the mean ATD response to the pediatric volunteer 95% CI. The LODC exhibited lower forward head excursion (262 mm) compared to pediatric volunteers (263 - 333 mm) in low-speed frontal sled tests (p<0.05), but was closer to the pediatric volunteers than the HIII 10 (179 mm) and Q10 (171 mm). In lateral swerving, the LODC (429 mm) exhibited greater lateral head excursion (p<0.05) compared to pediatric volunteers (115 - 171 mm). The LODC exhibited a greater reduction in kinematics compared to the pediatric volunteers in all loading conditions with a pre-pretensioner. These data provide valuable insight into the biofidelity of the LODC in non-traditional loading conditions, such as evaluating pre-crash maneuvers on occupant response.

Role of myofascial release technique on mobility and function in temporomandibular joint disorder patients with neck pain

Context: Temporomandibular disorders are musculoskeletal condition presenting with pain and dysfunction in masticatory muscles, temporomandibular joint (TMJ) and related structure. Aim: To determine the role of myofascial release technique on mobility and function in TMJ Disorder patients with neck pain. Settings and Design: Experimental study design conducted in Dr. D.Y. Patil College of Physiotherapy, Pimpri, Pune. Subjects and Methods: Overall 30 subjects who fulfilled the inclusion criteria were randomly divided into two groups. Experimental group (Group A) was given nonsteroidal anti-inflammatory drugs (NSAID's) and myofascial release to Upper trapezius, Sternocleidomastoid, Masseter and Temporalis three times a week for 2 weeks. Control group (Group B) was given NSAID's. At the end of treatment prepost comparison was done for temporomandibular (TM) joint range of motion and function. Statistical Analysis Used: Data was analysed with Primer software using Wilcoxon signed rank sum test and Mann–Whitney U-test. Results: Mobility in terms of mouth opening and lateral excursion post intervention in both groups have been significantly improved, however, in the experimental group significant improvement was seen in lateral excursions only. Limitation of daily function score reduced from 22.2 to 5 in the experimental; group and 21.3–13.5 in the control group. However more statistical reduction was seen in the experimental group (P = 0.001). Conclusions: Myofascial release technique along with NSAIDSs was able to improve mobility and function among the TM joint disorder patients with neck pain.

Functional Analysis of Rhythmic Jaw Movements Evoked by Electrical Stimulation of the Cortical Masticatory Area During Low Occlusal Loading in Growing Rats.

The maturation of rhythmic jaw movements (RJMs) and related neuromuscular control has rarely been studied in animals, though this process is essential for regulating the development of stomatognathic functions. Previous studies have shown that occlusal hypofunction during growth alters masticatory performance. However, little is known about patterns of cortically-induced RJMs under conditions of soft-diet feeding during development. The aim of this study is to clarify the effect of low occlusal loading on the pattern of cortically induced RJMs and related neuromuscular responses in growing rats. Sixty-four 2-week-old male albino Wistar rats were randomly divided into two groups and fed on either a normal diet (control) or soft diet (experimental) soon after weaning. At 5, 7, 9, and 11 weeks of age, electromyographic (EMG) activity was recorded from the right masseter and anterior digastric muscles along with corresponding kinematic images in RJMs during repetitive intracortical microstimulation of the left cortical masticatory area (CMA). Rats in both groups showed an increase in gape size and lateral excursion until 9 weeks of age. The vertical jaw movement speed in both groups showed no significant difference between 5 and 7 weeks of age but increased with age from 9 to 11 weeks. Compared to the control group, the average gape size and vertical speed were significantly lower in the experimental group, and the pattern and rhythm of the jaw movement cycle were similar between both groups at each recording age. EMG recordings showed no age-related significant differences in onset latency, duration, and peak-to-peak amplitude. Moreover, we found significantly longer onset latency, smaller peak-to-peak amplitude, and greater drop-off mean and median frequencies in the experimental group than in the control group, while there was no significant difference in the duration between groups. These findings indicate that a lack of enough occlusal function in infancy impedes the development of patterns of RJMs and delays the neuromuscular response from specific stimulation of the CMA.

A novel Movement Amplification environment reveals effects of controlling lateral centre of mass motion on gait stability and metabolic cost.

During human walking, the centre of mass (COM) laterally oscillates, regularly transitioning its position above the two alternating support limbs. To maintain upright forward-directed walking, lateral COM excursion should remain within the base of support, on average. As necessary, humans can modify COM motion through various methods, including foot placement. How the nervous system controls these oscillations and the costs associated with control are not fully understood. To examine how lateral COM motions are controlled, healthy participants walked in a ‘Movement Amplification’ force field that increased lateral COM momentum in a manner dependent on the participant's own motion (forces were applied to the pelvis proportional to and in the same direction as lateral COM velocity). We hypothesized that metabolic cost to control lateral COM motion would increase with the gain of the field. In the Movement Amplification field, participants were significantly less stable than during baseline walking. Stability significantly decreased as the field gain increased. Participants also modified gait patterns, including increasing step width, which increased the metabolic cost of transport as the field gain increased. These results support previous research suggesting that humans modulate foot placement to control lateral COM motion, incurring a metabolic cost.

Right ventricular speckle tracking analysis in patients with mitral stenosis

The 2D-speckle tracking is a new echocardiographic tool to have an objective and angle-independent quantification of myocardial deformation. Recent developments were performed for the quantification of longitudinal dynamic right ventricular deformation. We aimed to evaluate the role of two-dimensional (2D) strain imaging in the assessment of subclinical RV dysfunction. Fifty patients with rheumatic mitral stenosis (MS group) and 20 control healthy patients were recruited and had had standard echocardiography and Doppler echocardiography. The right ventricular functions were determined by conventional methods and two-dimensional (2D) longitudinal strain. There were no significant differences in age, sex, Body mass index and Left ventricular ejection fraction. Mitral valve area in MS group (1.38 ± 0.5 cm vs. 3 ± 0 cm), left atrial surface (31.68 ± 8.5 cm 2 vs. 13.5 ± 1.4 cm 2 ), and Pulmonary systolic arterial pression (44.64 ± 12.4 mmHg vs. 22.7 ± 2.7 mmHg) were higher in MS group. Conventional echocardiographic modalities of RV function were analysed: Peak systolic velocity at the lateral tricuspid annulus (S’: 12.24 ± 2.8 cm/s vs. 18.6 ± 1 cm/s) and tricuspid annular systolic excursion (TAPSE) were lower in MS group (18.7 ± 4.07 vs. 26.7 ± 0.7). Two-dimensional longitudinal strain was significantly decreased in MS group (−14.1 ± 4.2 vs. −19.3 ± 1.6) and was correlated to mitral valve area ( P = 0.03). There was a correlation between conventional methods (S’ and TAPSE) and RV-strain (RV-strain- S’: P = 0.001; RV strain-TAPSE: P = 0.01). We demonstrated that patients with MS had lower RV functions using 2D strain imaging. 2D strain imaging appears to be useful in the detection of subclinical RV dysfunction in patients with MS.