Outward Rotation Research Articles

Efficacy Comparison of Low Level Laser Treatment with Muscle Energy Procedure Among Diabetic Patients Suffering from Frozen Shoulder

Frozen shoulder incidence in diabetic patient is twice as high as normal controls. There are various conventional as well as electrotherapies for its treatment within which low-level laser therapy versus muscle energy technique are well debated for efficacy in diabetic patients frozen shoulder. Objective: Comparative analysis of effectiveness of low-level laser therapy and muscle energy technique among diabetic patients with frozen shoulder. The study design was comparative study. The Place and Duration of Study was Department of Orthopaedic, Indus Medical College, Tando Muhammad Khan from 1st January 2023 to 30th June 2023. Methods: One hundred and twenty patients who were having diabetes mellitus (type 1 and type 2) and suffering from frozen shoulders were enrolled. The conventional therapeutic exercise included exercises like pendulum, arm overhead, finger wall ladder, twisting arm outwards, overhead pulley, cross-body reach exercises, hand behind-back exercise and outward rotation exercise. Muscle energy technique was administered in cases where restriction in shoulder flexion, as well as abduction, external rotation was observed. Results: There were 59% females and 41% males with majority being within the age group of 45-65 years. It was observed that there was a significant variance between pain scores at pretreatment and post treatment stages with highest value decrease observed in muscle energy technique group II. The ROM was least improved in control group only treated through conventional protocol. Conclusions: The Muscle energy technique is slightly more effective than low-level laser therapy technique in terms of pain, inflammation reduction and angular movements.

Validation of the hind feet position score and its association with heel height difference in dairy cows.

Hind feet position scoring (HFPS) categorizes the outward rotation of the hind feet from the line parallel to the midline of the body in standing dairy cows. It has previously been used as an indication of both differences in heel height between the lateral and medial hind claw (to determine the need of hoof trimming) and the presence of claw lesions in sound cattle. In this observational study, the agreement of HFPS with other types of hoof angle measurements, as well as its association with the heel height difference (HHD) between the claws were investigated.A total of 51 dairy cows were assessed independently by three observers in two measuring rounds on two different measuring days each. On each occasion, they scored the HFPS, and measured the angle of outward rotation of both hind feet using a digital protractor (DIG) and a compass app (COMP). Heel height difference was measured only during the second occasion. Intra- and interobserver agreement were calculated using weighted kappa statistics (HFPS) and intraclass correlation (DIG, COMP and HHD). Associations between HFPS and DIG, COMP and HHD were analyzed using linear mixed models.Intra- and interobserver reliability were poor to good for HFPS, DIG, COMP and HHD. HFPS was significantly associated with DIG and COMP but not with HHD. Using the median value of repeated HFPS scores could increase the robustness of the HFPS assessment, as our data indicate that the cows frequently shift the position of their hind claws. Overall, there was a poor correlation between HHD and HFPS, so HFPS may not be determined by HHD alone; future research should consider other reasons for outward rotation of the hind feet.

Evaluation of mandibular condyle position in Class III patients after bimaxillary orthognathic surgery: A cone-beam computed tomography study.

This retrospective study evaluated the mandibular condyle position before and after bimaxillary orthognathic surgery performed with the mandibular condyle positioned manually in patients with mandibular prognathism using cone-beam computed tomography. Overall, 88 mandibular condyles from 44 adult patients (20 female and 24 male) diagnosed with mandibular prognathism due to skeletal Class III malocclusion who underwent bilateral sagittal split ramus osteotomy (BSSRO) and Le Fort I performed using the manual condyle positioning method were included. Cone-beam computed tomography images obtained 1-2 weeks before (T0) and approximately 6 months after (T1) surgery were analyzed in three planes using 3D Slicer software. Statistical significance was set at P < 0.05 level. Significant inward rotation of the left mandibular condyle and significant outward rotation of the right mandibular condyle were observed in the axial and coronal planes (P < 0.05). The positions of the right and left condyles in the sagittal plane and the distance between the most medial points of the condyles in the coronal plane did not differ significantly (P > 0.05). While the change in the sagittal plane can be maintained as before surgery with manual positioning during the BSSRO procedure, significant inward and outward rotation was observed in the axial and coronal planes, respectively, even in the absence of concomitant temporomandibular joint disorder before or after the operation. Further long-term studies are needed to correlate these findings with possible clinical consequences.

Improvement of the temporomandibular joint symptoms due to the condylar position change following modified L-shaped intraoral vertico-sagittal ramus osteotomy: a single-center, retrospective study.

Intraoral vertico-sagittal ramus osteotomy (IVSRO) was first reported by Choung in 1992 as a surgical procedure to decrease postoperative condylar dislocation. In 2017, Iwanaga et al. developed modified L-shaped IVSRO (mIVSRO) to reduce postoperative nerve dysfunction and achieved favorable outcomes. This study aimed to clarify the effect of mIVSRO on changes in temporomandibular joint (TMJ) symptoms and three-dimensional condylar position. We conducted a retrospective study of thirty sides in fifteen Japanese adults diagnosed with jaw deformities who underwent mIVSRO and sagittal split ramus osteotomy (SSRO). TMJ symptoms were assessed chronologically, and the condylar long axis and the condylar position were analyzed two- and three-dimensionally using axial cephalograms and cone-beam computed tomography. Postoperative TMJ symptoms improved by 90% (9/10 sides) in the mIVSRO group and by 50% (7/14 sides) in the SSRO group. The mIVSRO group exhibited outward rotation of the condylar long axis, while the SSRO group exhibited inward rotation. Moreover, mIVSRO induced residual anteromedial-inferior deviation of the condyle. The inclination angle of the condylar process was not significantly different between the two procedures pre- and postoperatively. These results clearly demonstrated the effect of mIVSRO on symptomatic TMJ. Residual changes in the position of the condyle following mIVSRO may not affect jaw function.

Evaluation of a Savonius wind turbine in the vicinity of a circular cross-sectional building

Today's urban areas are filled with tall buildings that require significant energy. To enable the implementation of small-scale wind turbines for dispersed electricity generation in cities, it is crucial to evaluate their performance in close proximity to buildings. This study aims to assess the performance of conventional Savonius rotors near a circular cross-sectional building for the first time. The performance of a Savonius wind rotor is being studied at different installation angles (30°, 45°, 60°, and 90°) with a constant non-dimensional gap space (S/D) of 2.0 between the rotor center and building envelope under a constant free-wind speed of 6 m/s. Two possible wind rotor rotation scenarios, inward and outward, are thoroughly tested and studied. Computations are carried out for tip speed ratios (TSR) of 0.4, 0.8, and 1.2. The obtained results are successfully validated for both the Savonius rotor in the free-wind flow (without a building) and a circular cross-sectional building (without a wind rotor) as well. The results show that installing a Savonius rotor at angles of 60° and 90° provides the maximum power coefficient based on the TSR. In contrast, placing the rotor at 30° reduces its performance even more than the reference case. For optimal rotor angles, inward rotation is preferred over outward rotation regardless of the TSR. Finally, there are improvements of 208.72 %–439.95 % compared to the reference case for 60° and 90° under inward rotation.

Onychomycosis in Foot and Toe Malformations.

Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses. However, the role of direct trauma in the pathogenesis of fungal nail infections has only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated. Aimof the study: This is a multicenter single-author observational study over a period of 6 years performed at specialized nail clinics in three countries. All patient photographs taken by the author during this period were screened for toenail alterations, and all toe onychomycosis cases were checked for whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe, and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture, or polymerase chain reaction (PCR) were accepted. Results: Of 1653 cases, 185 were onychomycoses, proven by mycologic culture, PCR, or histopathology. Of these, 179 involved at least one big toenail, and 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease, and onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), while hallux erectus was observed in 43 patients, and the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role in the localization of the fungal infection, as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with a determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration, and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency, and iatrogenic immunosuppression, whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or correct. Generally, when explaining the treatment of onychomycoses to patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory.

CICATRICIAL ECTROPION REPAIR DUE TO TRAUMA : A CASE REPORT

Introduction : Cicatricial ectropion is a complication that can occur after trauma. Scar tissue formation causes anterior lamellae shortening (skin and orbicularis muscle), resulting in outward lid margins rotation.&#x0D; Case Illustration : A 16 y.o male patient came with complaints of the left upper and lower eyelids folding outwards since 3 months ago after trauma, watery eye. Examination VOD 20/20, VOS 20/50. Scar on the superior and inferior lids, the inferior lid margin is folded out, inferior tarsal conjunctiva is visible, lagophthalmus 4 mm, fissure palpebral vertical (FPV) 12 mm, margin reflex distance (MRD) 1 = 4 mm, MRD2 = 8 mm, fissure palpebral horizontal (FPH) 30 mm, conjunctival injection. Corneal (macular) scars central-peripherally at 3-6 o'clock. Patient was diagnosed with cicatrical ectropion with left eye corneal scar and ectropion repair was performed with full-thickness skin graft from retroarticular. One week and six weeks after surgery, FPV improved to 10 mm, MRD1 = 4, MRD2 = 6 mm, FPH 30 mm, and lagophthalmos 2 mm became 1 mm.&#x0D; Discussion : Cicatricial ectropion is usually treated in 3 procedures: release vertical scar traction, horizontal lid tightening, repair anterior lamella can be done with full-thickness skin graft. horizontal lid tightening in this case not carried out because of no laxity.&#x0D; Conclusion : Scar traction release and repair anterior lamella with full-thickness skin graft from retroauricular was choice in this case because extensive defect and ectropion grade 3. After surgery anatomical structure of the lids and looks better aesthetically.

Mechanism of hydrophobic gating in the acetylcholine receptor channel pore.

Neuromuscular acetylcholine receptors (AChRs) are hetero-pentameric, ligand-gated ion channels. The binding of the neurotransmitter acetylcholine (ACh) to two target sites promotes a global conformational change of the receptor that opens the channel and allows ion conduction through the channel pore. Here, by measuring free-energy changes from single-channel current recordings and using molecular dynamics simulations, we elucidate how a constricted hydrophobic region acts as a "gate" to regulate the channel opening in the pore of AChRs. Mutations of gate residues, including those implicated in congenital myasthenia syndrome, lower the permeation barrier of the channel substantially and increase the unliganded gating equilibrium constant (constitutive channel openings). Correlations between hydrophobicity and the observed free-energy changes, supported by calculations of water densities in the wild-type versus mutant channel pores, provide evidence for hydrophobic wetting-dewetting transition at the gate. The analysis of a coupled interaction network provides insight into the molecular mechanism of closed- versus open-state conformational changes at the gate. Studies of the transition state by "phi"(φ)-value analysis indicate that agonist binding serves to stabilize both the transition and the open state. Intersubunit interaction energy measurements and molecular dynamics simulations suggest that channel opening involves tilting of the pore-lining M2 helices, asymmetric outward rotation of amino acid side chains, and wetting transition of the gate region that lowers the barrier to ion permeation and stabilizes the channel open conformation. Our work provides new insight into the hydrophobic gate opening and shows why the gate mutations result in constitutive AChR channel activity.

Intermediate conformations of CD4-bound HIV-1 Env heterotrimers

HIV-1 envelope (Env) exhibits distinct conformational changes in response to host receptor (CD4) engagement. Env, a trimer of gp120 and gp41 heterodimers, has been structurally characterized in a closed, prefusion conformation with closely associated gp120s and coreceptor binding sites on gp120 V3 hidden by V1V2 loops1–4 and in fully saturated CD4-bound open Env conformations with changes including outwardly rotated gp120s and displaced V1V2 loops3–9. To investigate changes resulting from substoichiometric CD4 binding, we solved single-particle cryo-electron microscopy (cryo-EM) structures of soluble, native-like heterotrimeric Envs bound to one or two CD4 molecules. Most of the Env trimers bound to one CD4 adopted the closed, prefusion Env state, with a minority exhibiting a heterogeneous partially open Env conformation. When bound to two CD4s, the CD4-bound gp120s exhibited an open Env conformation including a four-stranded gp120 bridging sheet and displaced gp120 V1V2 loops that expose the coreceptor sites on V3. The third gp120 adopted an intermediate, occluded-open state10 that showed gp120 outward rotation but maintained the prefusion three-stranded gp120 bridging sheet with only partial V1V2 displacement and V3 exposure. We conclude that most of the engagements with one CD4 molecule were insufficient to stimulate CD4-induced conformational changes, whereas binding two CD4 molecules led to Env opening in CD4-bound protomers only. The substoichiometric CD4-bound soluble Env heterotrimer structures resembled counterparts derived from a cryo-electron tomography study of complexes between virion-bound Envs and membrane-anchored CD4 (ref. 11), validating their physiological relevance. Together, these results illuminate intermediate conformations of HIV-1 Env and illustrate its structural plasticity.

Lower Limb Biomechanics during the Golf Downswing in Individuals with and without a History of Knee Joint Injury.

Although prevention is better than treatment, after a knee injury occurs, the adjustment of the movement technique back to the posture before the injury and the restoration of accuracy is very important for professional and amateur players. This study aimed to compare the differences in lower limb mechanics during the golf downswing between those with and without a history of knee joint injury. A total of 20 professional golfers with single-digit handicaps were recruited for this study, 10 of whom had a knee injury history (KIH+), while another 10 players were without a knee injury history (KIH-). From the 3D analysis, selected kinematic and kinetic parameters during the downswing were analyzed using an independent samples t-test with a significance level of α = 0.05. During the downswing, individuals with KIH+ exhibited a smaller hip flexion angle, smaller ankle abduction angle, and larger ankle adduction/abduction range of motion (ROM). Moreover, there was no significant difference found in the knee joint moment. Athletes with a history of knee injury can adjust the motion angles of their hip and ankle joints (e.g., by avoiding excessive forward leaning of the trunk and maintaining stable foot posture without inward or outward rotation) to minimize the impact of changes in their movement patterns resulting from the injury.

Effect of Component Position and Inward–Outward Rotation on the Wear of Different Ultra-High Molecular Weight Polyethylenes in an Orbital Bearing Type Hip Joint Simulator

The orbital bearing machine is the world’s most widely used hip joint simulator design for wear testing of prosthetic hips. It has been used with inverted and anatomic component position and with and without inward–outward rotation. Still the effect of component position on the wear of the most widely used bearing material, ultrahigh molecular weight polyethylene (UHMWPE), has not been studied directly. With a modified orbital bearing machine, the effects of the component position, anatomic versus inverted, and of the inward–outward rotation, present versus absent, on polyethylene wear were studied for the first time. Acetabular liners made from different ultra-high molecular weight polyethylenes articulated against alumina femoral heads in alpha calf serum. The inverted position resulted in the most realistic, burnished appearance of the polyethylene bearing surfaces. In the inverted position, the wear rate decreased with increasing gamma dose that is known to improve wear resistance by cross-linking. In the anatomic position, the bearing surface was not always entirely burnished. The wear was similar with and without inward–outward rotation. The mean wear rate of vitamin E stabilized highly cross-linked ultra-high molecular weight polyethylene was close to clinical observations. Clinically relevant wear could be produced with the orbital bearing machine for both established and advanced bearing materials. The inverted position appeared preferable in the orbital bearing machine. Inward–outward rotation did not appear important.

Structural Analysis of Spermidine Synthase from Kluyveromyces lactis.

Spermidine is a polyamine molecule that performs various cellular functions, such as DNA and RNA stabilization, autophagy modulation, and eIF5A formation, and is generated from putrescine by aminopropyltransferase spermidine synthase (SpdS). During synthesis, the aminopropyl moiety is donated from decarboxylated S-adenosylmethionine to form putrescine, with 5'-deoxy-5'-methylthioadenosine being produced as a byproduct. Although the molecular mechanism of SpdS function has been well-established, its structure-based evolutionary relationships remain to be fully understood. Moreover, only a few structural studies have been conducted on SpdS from fungal species. Here, we determined the crystal structure of an apo-form of SpdS from Kluyveromyces lactis (KlSpdS) at 1.9 Å resolution. Structural comparison with its homologs revealed a conformational change in the α6 helix linked to the gate-keeping loop, with approximately 40° outward rotation. This change caused the catalytic residue Asp170 to move outward, possibly due to the absence of a ligand in the active site. These findings improve our understanding of the structural diversity of SpdS and provide a missing link that expands our knowledge of the structural features of SpdS in fungal species.

Cryo-EM visualization of state transition during non-homologous end-joining (NHEJ).

DNA double-strand breaks (DSBs) are a highly cytotoxic form of DNA damage and the incorrect repair of DSBs is linked to carcinogenesis. The conserved error-prone non-homologous end joining (NHEJ) pathway has a key role in determining the effects of DSB-inducing agents that are used to treat cancer as well as the generation of the diversity in antibodies and T cell receptors. Using single-particle cryo-electron microscopy, we visualized key DNA-protein complexes that are formed by human NHEJ factors. A near-complete NHEJ reaction cycle and a life cycle of DNA-PKcs (catalytic subunit of the DNA-dependent protein kinase) are proposed from the models. The Ku70/80 heterodimer (Ku), DNA-PKcs, XRCC4 and XLF first form a long-range synaptic complex in which the DNA ends are held approximately 115 Å apart. Two DNA end-bound subcomplexes comprising Ku and DNA-PKcs are linked by interactions between the DNA-PKcs subunits and a scaffold comprising LigIV, XRCC4, and XLF. The relative orientation of the DNA-PKcs molecules suggests a mechanism for autophosphorylation in trans, which leads to substantial outward rotation of both Ku and DNA-PKcs to promote DNA double-strand break exposure and DNA-PKcs dissociation. Upon DNA-PKcs dissociation, the long-range synaptic complex transit into the short-range synaptic complex, within which the Ku-bound DNA ends are aligned for processing and ligation by the XLF-anchored scaffold, and a single catalytic domain of LigIV is stably associated with a nick between the two Ku molecules, suggesting that the joining of both strands of a DSB involves both LigIV molecules. In addition, we captured a dimeric state of catalytically inactive DNA-PKcs, which resembles previously determined structures of PIKK family kinases, revealing a model of the full life cycle of DNA-PKcs during NHEJ.

Effects of different distractor positions on the formation of expansion, stress and displacement patterns in surgically assisted rapid maxillary expansion without pterygomaxillary disjunction: a finite element analysis study

Skeletal orthopedic expansion of maxilla is accepted as a reliable method for the treatment of transverse maxillar deficiency in growing patients. The aim of the study was to evaluate the effects of different palatal distractor positions on the expansion, stress and displacement patterns of the structures of craniofacial complex in surgical assisted rapid maxillary expansion without pterygomaxillary disjunction (PTMD) with the help of finite element analysis(FEA). Four facial skeleton models with different distractor positions (first premolar, second premolar, first molar, second molar regions) were created. In all finite element models median and lateral osteotomies were performed, without PTMD. Stress distribution was evaluated after 5 mm activation of the transpalatal distraction in all models using the nonlinear solution method in FEA. Unilateral displacement(mm) and stress distribution(MPa) were measured in three directions (x, y, and z axes) of craniofacial and maxillofacial structures in the symmetrical finite element models. In all models, the unilateral transverse displacements of the anterior teeth were greater than those of the posterior teeth, and the greatest displacement was at the central incisor level. The greatest displacement values at the central incisor level, at the anterior nasal spine(ANS) and at the posterior nasal spine(PNS) levels was measured in Model-IV, III, II and I, respectively. Mean elemental stress(von Mises stress) in the medial pterygoid plate, screw and lateral pterygoid plate regions from highest to lowest was measured in Model-IV, III, II and I, respectively. The maxilla performed outward rotation and tipping movement in all models during the expansion period. Among the distractor positions, the second molar region was found to be the most advantageous one in terms of expansion pattern. Considering the patient’s anatomy and clinical conditions, placing the palatal distractor as posteriorly as possible will result in more effective maxillary expansion.

Comparison of Intermolecular Interactions of Irreversible and Reversible Inhibitors with Bruton's Tyrosine Kinase via Molecular Dynamics Simulations.

Bruton's tyrosine kinase (BTK) is a key protein from the TEC family and is involved in B-cell lymphoma occurrence and development. Targeting BTK is therefore an effective strategy for B-cell lymphoma treatment. Since previous studies on BTK have been limited to structure-function analyses of static protein structures, the dynamics of conformational change of BTK upon inhibitor binding remain unclear. Here, molecular dynamics simulations were conducted to investigate the molecular mechanisms of association and dissociation of a reversible (ARQ531) and irreversible (ibrutinib) small-molecule inhibitor to/from BTK. The results indicated that the BTK kinase domain was found to be locked in an inactive state through local conformational changes in the DFG motif, and P-, A-, and gatekeeper loops. The binding of the inhibitors drove the outward rotation of the C-helix, resulting in the upfolded state of Trp395 and the formation of the salt bridge of Glu445-Arg544, which maintained the inactive conformation state. Met477 and Glu475 in the hinge region were found to be the key residues for inhibitor binding. These findings can be used to evaluate the inhibitory activity of the pharmacophore and applied to the design of effective BTK inhibitors. In addition, the drug resistance to the irreversible inhibitor Ibrutinib was mainly from the strong interaction of Cys481, which was evidenced by the mutational experiment, and further confirmed by the measurement of rupture force and rupture times from steered molecular dynamics simulation. Our results provide mechanistic insights into resistance against BTK-targeting drugs and the key interaction sites for the development of high-quality BTK inhibitors. The steered dynamics simulation also offers a means to rapidly assess the binding capacity of newly designed inhibitors.

Experimental investigation of the effect of inward and outward propeller rotation on single blade and propeller loads

This paper is a sequel of the experimental investigation presented in Ortolani and Dubbioso (2019a) that addressed the single blade and propeller loads during the steady phase of the turning circle. In particular, the effect of inward and outward propeller sense of revolution on the propulsive performance has been investigated for a twin screw ship model equipped with a novel set-up pursued for the measurements of the single blade loads. On the basis of previous numerical investigations (Muscari et al., 2017; Dubbioso et al., 2022), the propeller sense of revolution should be evaluated as a passive mean to mitigate the amplification of the mean or fluctuating component of the blade loads and associated side effects (i.e., noise) caused by blade–wake interactions that occur during maneuvering conditions. The understanding and the accurate quantification of propeller loads, in these realistic operative scenario, is pivotal to design low emission and comfortable ships, fulfilling the requirements of safety and continuity of operations at sea. The analysis is carried out revisiting the investigation in Ortolani and Dubbioso (2019a) for the approach speed at FN=0.26 and a large set of rudder angles that span from moderate to tight maneuvers.

Design and Fabrication of Rehabilitation Instrument for Upper and Lower Limb

Abstract: In today’s world, most of the people have a busy and hectic schedule. They hardly get time to look after their physical health which then affects them in their elderly age or in some cases at a young age. To take care of such physical problems rehabilitation is necessary. Rehabilitation improves and returns functional capacity and quality lifespan of people with physical injuries or disorders. Rehabilitation is not only used for treatment of physical diseases but also in sports industry. It helps in fast recovery of athletes and increases their performance on the field. Our project proposes a design of a rehabilitation instrument for upper and lower limbs. The upper limb rehabilitation instrument is designed for our shoulders and arm. It is designed to provide natural shoulder and arm movements in all directions possible. The lower limb rehabilitation instrument focuses mostly on knee and ankle joints and the EMS (Electro –Muscle Stimulator) is used to send external electric signals to the inactive muscles (muscles which have lost contact with the brain). The external electric signals sent are similar to the signals sent by brain to muscles. These signals help in contraction and expansion of muscles and thus, help in movement of that part of the body. The Rehabilitation instrument we are developing would be user-friendly, compact and budget friendly. Index Terms: Rehabilitation, Upper limb, Lower limb, Shoulder flexion, Shoulder extension, elbow inward rotation, elbow outward rotation, Paralysis, Physiotherapy.

The foot drawing method: reliability of measuring foot length and outward rotation in children with clubfoot

BackgroundThe Ponseti method is the gold standard for clubfoot treatment. However, relapse and residual gait deviations are common, and follow-up until 7 years of age is recommended. We evaluated the reliability of the foot drawing method, a new instrument for the follow-up of clubfoot. The method uses drawings of the foot in the neutral position and external rotation to measure foot length and outward rotation.MethodsNineteen children aged 2.5–7 years who were treated with the Ponseti method for congenital clubfoot were included. Two raters made the drawings twice (D1 and D2). Each rater measured foot length, foot rotation, and foot–tibial rotation independently (D1). Later, the raters repeated the measurements (D2). Interrater reliability was assessed using the D1 from each rater. Intrarater reliability was assessed using the measurements from each rater’s D1 and D2. Bland–Altman plots were used to visualize the limits of agreement (LoA). The mean, 95% confidence interval, and one standard deviation of the differences in all measurements were calculated.ResultsThe mean differences between and within raters were: foot length < 1 mm, foot rotation < 1°, and foot–tibia rotation < 2°, which indicated no systematic differences. The LoA for foot length were: 4.5 mm and 5.9 mm between raters for D1, − 4.8 mm and 5.9 mm for rater 1 (D1–D2), and − 5.1 mm and 5 mm for rater 2 (D1–D2). The LoA for foot rotation: were − 12° and 10.6° between raters (D1), − 8.4° and 6.6° for rater 1 (D1–D2), and − 14° and 14.1° for rater 2 (D1–D2). The LoA for foot–tibia rotation were: − 17.8° and 14.3° between raters (D1), − 12° and 12.2° for rater 1 (D1–D2), and − 12.7° and 13.6° for rater 2 (D1– D2).ConclusionsThe absence of systematic differences between and within raters, and LoA observed indicate that the foot drawing method is applicable in clinical practice and research. However, the results of the foot and foot–tibia rotation analyses imply that caution is needed when interpreting changes in foot rotation in feet with higher degrees of rotation.

Effect of brick arrangement on structural behaviour of Persian brick masonry barrel vaults by micro-modelling

In this paper, the effect of brick arrangement on structural behaviour of Persian brick masonry barrel vaults has been studied by the micro-modelling method using non-linear finite element analysis performed by the ANSYS code. Vaults have semi-circular, pointed and four-centred cross-sectional shapes. Two different spans and three different lengths, with Roman brick arrangement and Persian brick arrangement have been considered. The vaults have been subjected to linear load at mid-span, linear load at one-third-span, support settlement, inward rotation of one support, inward rotation of two supports and outward rotation of two supports. In the cases of linear load at mid-span and support settlement, the Persian brick arrangement is more satisfactory in the semi-circular and pointed vaults, and the Roman brick arrangement is favoured in the four-centred vault. In the case of linear load applied at one-third-span, the load-bearing capacity provided by the Persian brick arrangement is up to two times the Roman brick arrangement. When one support rotates inwards, the Roman brick arrangement is always better. For both cases of inward and outward rotation of two supports, the performance of the Persian brick arrangement is more satisfactory in pointed and four-centred vaults, and that of Roman brick arrangement is better in the semi-circular vault.

Assessment of knee flexor muscles strength in patients with patellar instability and its clinical implications for the non-surgical treatment of patients after first patellar dislocation - pilot study

BackgroundBiomechanical studies indicate that during outward rotation of the tibia and the valgus knee joint position, the patella is shifted in the lateral direction. After first-time patellar dislocation, the dynamic position of the femur in relation to the tibia plays an important role in joint stability, because the medial stabilizer of the patella (mostly the MPFL) is damaged or inefficient. The most important factor in controlling the rotational movement of the tibia in relation to the thigh are the hamstring muscles. The aim of the study therefore is to determine whether patients with patellar instability have a significant weakness in the knee flexor muscles, which can predispose to recurrent dislocations. This is an important consideration when planning the rehabilitation of patients with first-time patellar dislocation.MethodsThe study enrolled 33 patients with confirmed recurrent patellar dislocation, including six patients with bilateral involvement. In the study group, the hamstring muscles (both sides) were evaluated at velocities of 60 and 180 deg/s for the following parameters: peak torque, torque at 30 degrees of knee flexion, angle of peak torque and peak torque hamstring to quadriceps ratio (H/Q ratio).ResultsIn the recurrent patellar dislocation group, a statistically significant weakness in knee flexors was observed for both angular velocities compared to age and gender normative data. No such relationship was observed in the control group of heathy subjects. In patients with one-sided dislocation, no differences were found in knee flexors peak torque, torque at 30 degrees of knee flexion, angle of peak torque or H/Q ratio between the healthy and affected limbs for either angular velocity.ConclusionsIn patients with recurrent patellar dislocation, knee flexors strength is decreased significantly in both the unaffected and affected limbs. This may indicate a constitutional weakening of these muscles which can predispose to recurrent dislocations.Trial registrationThe study was retrospectively registered on ClinicalTrials.gov (NCT04838158), date of registration; 22/03/2021.