Shoulder Region Research Articles

The effect of motor and functional independence of disabled children on musculoskeletal disorders in pediatric caregivers: A cross-sectional study

Background/Aim: There are conflicting results regarding the effect of motor and functional independence levels of disabled children on the burden of care. In addition, this burden, as well as musculoskeletal problems of pediatric caregivers, has not been examined in detail. The aim of this study is to examine the effects of motor and functional levels of the disabled child.
 Methods: The study was planned as a single-blind, multicenter, cross-sectional study. Children between ages 1-12 with physical disabilities from various problems, and 65 caregivers over the age of 18 who cared for them for at least 6 months, were included. Caregivers were divided into two groups, as per the BAKAS Caregiver Impact Scale score as high care burden (n = 33) or low care burden (n = 32). The motor level of the disabled child was determined by the Gross Motor Function Classification System, and the functional level of the Pediatric Functional Independence Measurement. The Nordic Musculoskeletal Questionnaire was used to evaluate musculoskeletal problems in caregivers.
 Results: There was no significant difference between the Gross Motor Function Classification System levels of children in groups (P > 0.05). The Pediatric Functional Independence Measurement scores of children in the high care burden group were significantly lower than those in the low care burden group (P < 0.05). According to a comparison of pain in parts of the body for 12 months, using the Nordic Musculoskeletal Questionnaire, the percentage of pain in the neck, shoulder, back, elbow, hand, hip, and foot regions of caregivers was significantly higher in the group with a high care burden (P < 0.05). There was no significant difference between percent of low back and knee pain in the last 12 months (P > 0.05). A weak positive correlation was found between the BAKAS Caregiver Impact scores and the Pediatric Functional Independence Measurement of children with disabilities (r = 0.26; P = 0.03).
 Conclusion: The lower functional level of the disabled child may cause an increase in caregiver burden of both the caregivers and musculoskeletal disorders.

Factors related to initial treatment for adhesive capsulitis in the medicare population

BackgroundPrimary adhesive capsulitis (AC) is not well understood, and controversy remains about the most effective treatment approaches. Even less is known about the treatment of AC in the Medicare population. We aimed to fully characterize initial treatment for AC in terms of initial treatment utilization, timing of initial treatments and treatment combinations.MethodsUsing United States Medicare claims from 2010–2012, we explored treatment utilization and patient characteristics associated with initial treatment for primary AC among 7,181 Medicare beneficiaries. Patients with primary AC were identified as patients seeking care for a new shoulder complaint in 2011, with the first visit related to shoulder referred to as the index date, an x-ray or MRI of the shoulder region, and two separate diagnoses of AC (ICD-9-CM codes: 726.00). The treatment period was defined as the 90 days immediately following the index shoulder visit. A multivariable logistic model was used to assess baseline patient factors associated with receiving surgery within the treatment period.ResultsNinety percent of beneficiaries with primary AC received treatment within 90 days of their index shoulder visit. Physical therapy (PT) alone (41%) and injection combined with PT (34%) were the most common treatment approaches. Similar patient profiles emerged across treatment groups, with higher proportions of racial minorities, socioeconomically disadvantaged and more frail patients favoring injections or watchful waiting. Black beneficiaries (OR = 0.37, [0.16, 0.86]) and those residing in the northeast (OR = 0.36, [0.18, 0.69]) had significantly lower odds of receiving surgery in the treatment period. Conversely, younger beneficiaries aged 66–69 years (OR = 6.75, [2.12, 21.52]) and 70–75 years (OR = 5.37, [1.67, 17.17]) and beneficiaries with type 2 diabetes had significantly higher odds of receiving surgery (OR = 1.41, [1.03, 1.92]).ConclusionsFactors such as patient baseline health and socioeconomic characteristics appear to be important for physicians and Medicare beneficiaries making treatment decisions for primary AC.

The Impact of NPV on the Spectral Parameters in the Yellow-Edge, Red-Edge and NIR Shoulder Wavelength Regions in Grasslands

Even though research has shown that the spectral parameters of yellow-edge, red-edge and NIR (near-infrared) shoulder wavelength regions are able to estimate green cover and leaf area index (LAI), a large amount of dead materials in grasslands challenges the accuracy of their estimation using hyperspectral remote sensing. However, the exact impact of dead vegetation cover on these spectral parameters remains unclear. Therefore, we evaluated the influences of dead materials on the spectral parameters in the wavelength regions of yellow-edge, red-edge and NIR shoulder by comparing normalized difference vegetation indices (NDVI) including the common red valley at 670 nm and NDVI using the red valley extracted by a new statistical method. This method, based on the concept of segmented linear regression, was developed to extract the spectral parameters and calculate NDVI automatically from the hyper-spectra. To fully understand the impact of dead cover on the spectral parameters (i.e., consider full coverage combinations of green vegetation, dead materials and bare soil), both in situ measured and simulated hyper-spectra were analyzed. The impact of dead cover on LAI estimation by those spectral parameters and NDVI were also evaluated. The results show that: (i) without considering the influence of bare soil, dead materials decreases the slope of red-edge, the slope of NIR shoulder and NDVI, while dead materials increases the slope of yellow-edge; (ii) the spectral characteristics of red valley disappear when dead cover exceeds 67%; (iii) large amount of dead materials also result in a blue shift of the red-edge position; (iv) accurate extraction of the red valley position enhances LAI estimation and reduces the influences of dead materials using hyperspectral NDVI; (v) the accuracy of LAI estimation using the slope of yellow-edge, the slope of red-edge, red-edge position and NDVI significantly drops when dead cover exceeds 72.3–74.5% (variation among indices).

The Effects of COVID-19 Lockdown on the Perception of Physical Activity and on the Perception of Musculoskeletal Symptoms in Computer Workers: Comparative Longitudinal Study Design.

Lockdown resulting from the pandemic led to a change in the health habits of the computer workers community. Sedentary work, together with less active lifestyles, aggravated by the COVID-19 pandemic leads to impacts on physical activity (PA) and can contribute to the development of musculoskeletal symptoms (MSS). Aim(s): Understand the effects of lockdown on the perception of physical activity levels and on the perception of frequency of musculoskeletal symptoms, over periods of 12 months and 7 days, in computer workers. Methods: Longitudinal comparative study between 2019 (M1) and 2021 (M2), over 18 months, in 40 volunteer participants. The inclusion criteria were full-time workers aged between 18 and 65 and the exclusion criteria included diagnosis of non-work-related medical conditions. In addition to a socio-demographic questionnaire, the Nordic musculoskeletal questionnaire (NMQ) was used to evaluate the MSS and the International Physical Activity Questionnaire (IPAQ), was used to analyse the perception of the level of PA. These questionnaires were used in two assessment stages (M1 and M2). McNemar test and Wilcoxon paired test were used to evaluate the effect of lockdown on the perception of PA, and on the perception of frequency of musculoskeletal symptoms. Results: The MSS prevalence in the previous 12 months increased significantly in the neck (M1: 45.0%, M2: 62.5%, p = 0.046), in the shoulders (M1: 37.5%, M2: 55.0%, p = 0.033), and in the hands/wrists (M1: 25.0%, M2: 45.0%, p = 0.019). The mean pain score increased in the shoulders (1.43 ± 2.24, 2.35 ± 2.55, p = 0.003) and in the elbows (0.18 ± 0.59, 0.60 ± 1.34, p = 0.015). No differences were found in the PA between M1 and M2, but the weekly mean sitting time increased from 4.75 ± 2.26 to 6.26 ± 2.65 (p < 0.001). Conclusion: After 18 months it became clear that MSS perception increased mainly in the neck, shoulders and hands/wrists with a significant increase in pain intensity in the shoulder and elbow regions. The weekly sitting time increased significantly. Further studies are needed in order to determine the impact of teleworking in a pandemic context. But multifactor behind these results should be taken into account by health institutions and those responsible for the Prevention of Occupational Risks in Computer Workers in order to adopt educational strategies for the promotion of Physical activity (PA), in these workers.

A Case Series on Morphological Variations of Biceps Brachii in Adult Human Cadavers and its Clinical Implications

Biceps brachii, a powerful forearm supinator, is a muscle in which many anatomical variations have been reported. Biceps brachii anomalies may play an important role in neurovascular compression syndromes in the arm and also affect shoulder joint movements. Three significant morphological variations in Biceps brachii were noted during routine dissection of upper limbs used for undergraduate teaching purposes. An extra articular origin of tendon of long head of Biceps brachii which was passing through the subpectoral tunnel formed by Pectoralis major was observed in one right upper limb. Nonfusion of two bellies of Biceps brachii with an accessory bicipital tendon was observed in one right upper limb. Presence of one supernumerary head of Biceps Brachii with a communicating branch between Median and Musculocutaneous nerves was observed in one right upper limb. Knowledge of these variations is essential for Surgeons and Orthopaedicians during surgery involving shoulder, arm and elbow regions. Key words: Biceps brachii, Supernumerary heads, Extra articular.

Musculoskeletal disorders related to dental hygienist profession.

ObjectivesMusculoskeletal disorders (MSDs) are occupational illnesses concerned with different classes of professionals; dental hygienists are among those. The aim of this trial is to evaluate MSDs prevalence and significance of the symptoms in a sample of dental hygienists.Materials and MethodsA 20‐question questionnaire was administered to a sample of dental hygienists, via social networks. The variables taken into consideration were personal data, hours of sport, working habits, years of professional activity, working hours and number of patients per week, presence or absence of pain.Statistical AnalysisData were evaluated using standard statistical analysis software, and an Excel database was created. Descriptive statistics were calculated for each variable. Group comparison was assessed by the chi‐square test of homogeneity and Fisher's exact test. (p‐value <0.05 as significant).Results468 questionnaires were examined: 396 females (85%) and 72 males (15%). The prevailing age was between 25 and 35. Among them, 91% referred to be suffering or have suffered MSDs. The most relevant affected muscular areas are neck (30.6%), shoulder (25.0%) and lumbosacral region (23.3%); the remaining 21.1% is divided among the other regions. Association and statistical analysis among the different variables showed how presence of MSDs negatively influences absenteeism and work performance; further research regarding ergonomics, type of seat, stretching and workout prevention would be important to strengthen the results collected.ConclusionsMusculoskeletal disorders diffusion among dental hygienists is particularly high due to lack of information; the majority of interviewees showed very little awareness of it; this led to a lack of effort in facing or possibly preventing these pathologies.

Clinical Study of Repetitive Transcranial Direct Current Stimulation Combined with Rehabilitation Therapy for Patients with Consciousness Disorder

<bold>Objective</bold> To explore the effect of repetitive transcranial direct current combined with rehabilitation therapy on promoting consciousness and improving spasticity in patients with consciousness disorder. <bold>Methods</bold> A retrospective analysis was performed on 42 patients with disturbance of consciousness，whom hospitalized in rehabilitation medicine department of Lanzhou University Second Hospital from April 2017 to April 2021. They were divided into observation group and control group according to whether they received transcranial direct current stimulation （tDCS），21 cases in each group. The control group were treated with conventional rehabilitation treatment and the observation group were treated with conventional rehabilitation therapy and tDCS，the anode was placed in the left primary motor cortex （M1） and the cathode was placed in the right shoulder region，current intensity of 2 mA，once daily，20 min once a day，5 times per week，for 6 weeks. Before and after treatment，the level of consciousness was assessed by the Coma Recovery Scale-Revised （CRS-R） and Glasgow Coma Scale （GCS），the Modified Ashworth Scale （MAS） was used to assess changes muscle tone of the right flexor elbow muscle. <bold>Results</bold> Before treatment，there were no significant difference in CRS-R and GCS scores between the two groups （<italic>P</italic>＞0.05）；After treatment，the scores of the two groups were improved，and the CRS-R and GCS scores of the observation group were better than the control group，the differences were statistically significant （<italic>P</italic>&lt;0.05）. In terms of clinical efficacy，there were 13 （38.10%） responders and 8 （61.90%） non responders in the observation group. In the control group，there were 2 （9.50%） patients with responded and 19 （90.50%） patients who did not respond，the difference between the two groups was significant difference （<italic>P</italic>&lt;0.05）. As for MAS score，there was no significant difference in MAS score of right flexor elbow muscle between the two groups before treatment （<italic>P</italic>＞0.05）; There was no significant difference in MAS score of bilateral flexor elbow muscle in the control group before and after treatment （<italic>P</italic>＞0.05），but there was significant difference in the observation group before and after treatment （<italic>P</italic>&lt;0.05）. Comparison among groups，MAS score of flexor elbow muscle in the observation group was better than the control group，the difference was significant difference （<italic>P</italic>&lt;0.05）. <bold>Conclusion</bold> Repetitive transcranial direct current stimulation combined with rehabilitation therapy can effectively improve the level of consciousness and spasticity of patients with consciousness disorder.

Superior UVA-photocatalytic antibacterial activity of a double-layer ZnO/Al2O3 thin film grown on cellulose by atomic layer deposition (ALD)

Cellulose fibers coated with a double-layer ZnO/Al2O3 thin film (cel/Al2O3/ZnO) were prepared in-situ by two successive processes of atomic layer deposition (ALD). Photoinactivation kinetics of Gram-negative (Escherichia coli) and Gram-positive (Staphylococcus aureus) bacteria were investigated in the dark and under UVA irradiation. Compared to the initial cellulose sample (cel) and cellulose coated with an Al2O3 thin film (cel/Al2O3), superior UVA photoinhibition was achieved for both bacteria treated with cel/Al2O3/ZnO within only 30 and 45 min of UVA irradiation for E. coli and S. aureus, respectively. FE-SEM and STEM micrographs showed strongly destructive effects on the morphology of both bacterial cell walls and the cytoplasmic membrane, which were attributed to the photogenerated reactive oxygen species (ROS). The kinetic data were successfully fitted using the modified Hom model, which consists of three rate constants describing the initial shoulder, rapid log-linear, and tail regions of the curves. As our results show, this cellulose-based material, further stabilized by the ALD Al2O3 interlayer, is promising for efficient photocatalytic disinfection of water.

Histopathological study of using Fetal caprine acellular dermal matrix alone and in combination with Non-thermal plasma in healing of full-thickness acute skin wounds in bucks

This study aimed to investigate the effect of non-thermal plasma (NTP) with Fetal caprine acellular dermal matrix (FCADM) scaffold in healing of the full-thickness acute skin wound in bucks. eighteen apparently healthy adult local breed bucks aged 1-2 years and weighing 25-30 kg were used. Each animal was subjected to creation of 4 full-thickness acute skin wounds on the shoulder region, two wounds on each side 10cm apart, the animals were divided into 3 groups, at first control group wounds were treated in routine way (cleaning the wound with normal saline every other day and dressing). The second group the wounds were treated with Fetal caprine acellular dermal matrix. The third group skin wounds were exposed to non-thermal plasma treatment with dose 6.6W/cm² for 30 sec (used probe 1cm in dimeter), then application of Fetal caprine acellular dermal matrix. The wounds were histopathologically evaluated at 3,7,21, 35 days post-operation using Hematoxylin &amp; Eosin (H&amp; E) and mason’s trichrome stain.

METHOD OF MACROMICROSCOPIC PREPARATION TO DETERMINE THE FETAL ANATOMICAL VARIABILITY OF THE STRUCTURES OF THE ANTERIOR SHOULDER AREA

It is known that the anterior shoulder region is characterized by unique structural features and anatomical relationships that play an important role in the functioning of the shoulder. Understanding the topography of the bones, ligaments, muscles, nerves, and vessels of the anterior shoulder region is necessary to eff ectively diagnose shoulder pathology, particularly with dysfunctions of various genesis and trauma. Examination of a patient with complaints of shoulder pain, depending on the degree of complexity, requires the use of additional research methods, the basis of which is knowledge of anatomical landmarks.The clinical value of using the algorithm for anatomical preparation of fascia, muscles, lymph nodes, blood vessels, and nerves of the anterior shoulder area in the practice of a surgeon allows for to prevention of their injury during complex surgical interventions.The study aimed to improve the technique of sequential preparation of fascia, muscles, vessels, and nerves of the anterior shoulder region in human fetuses to obtain standard results suitable for comparison in the age aspect.The study of fetal anatomy of the structures of the anterior shoulder area was carried out on 26 preparations of human fetuses of 4-10 months with the help of macromicroscopic dissection.On the anterior- medial surface of the shoulder, the landmark that determines the position of the vascular and nerve trunks is the medial edge of the biceps brachii muscle and its tendon. During macromicroscopic dissection of fetuses of diff erent ages, anatomical variability of the muscles of the anterior group of the shoulder, as well as vascular and nervous formations of the anterior shoulder area, was established. The obtained data on the technique of preparing the structures of the anterior shoulder area and the topographic and anatomical landmarks of its vascular and nervous formations in the fetal period of ontogenesis will contribute to the justifi cation of rational diagnostic and therapeutic techniques in fetal surgery.

Preoperative dynamic quantitative sensory testing in remote pain-free areas is associated with axial pain after posterior cervical spinal surgeries

BackgroundPostoperative axial pain (PAP), characterized by pain and/or stiffness around the posterior neck, periscapular areas and/or shoulder region, is a vexing complication affecting 5–60% of patients undergoing posterior cervical decompression. Given its relatively high frequency and negative impact on patients’ physical and mental status, efforts preoperatively to confirm patients at risk of developing PAP to offer more efficient pain management to minimize this complication have a high priority. The aim of this study is to investigate the role of preoperative dynamic quantitative sensory testing (QST) in predicting the PAP after posterior cervical decompression.MethodsThis longitudinal observational study included 122 patients with degenerative cervical myelopathy undergoing laminoplasty or laminectomy. Preoperatively, all patients underwent the assessment of pressure pain thresholds (PPTs) at local and remote pain-free areas and both temporal summation (TS) and conditioned pain modulation (CPM) at remote pain free-areas. These patients underwent further pain-related, psychosocial and clinical function assessments before and/or after operation.ResultsIn the present study, 21 patients (21/122, 17.2%) developed PAP, and the 6-month postoperative follow-up demonstrated that 8 of these 21 patients developed chronic PAP (CPAP). All preoperative covariates with significant differences between the PAP and non-PAP groups were subjected to multivariate logistic regression, and the presence of preoperative axial pain, surgical plan including C2 decompression, total international physical activity questionnaire score (cutoff value [CV]: 2205.5, sensitivity: 82.4%; specificity: 61.1%) and TS value (CV: 2.5, sensitivity: 42.9%; specificity: 83.2%) were independently associated with PAP (P < 0.05). Logistic regression further revealed that the presence of preoperative axial pain, TS value (CV: 2.5, sensitivity: 62.5%; specificity: 83.2%) and CPM value (CV: 0.65, sensitivity: 87.5%; specificity: 61.4%) were significant predictors of CPAP (P < 0.05).ConclusionsThe findings of this study support the hypothesis that preoperative endogenous pain modulation efficiency may be associated with axial pain after posterior cervical decompression. Clinically, preoperative estimation of both TS and CPM in remote pain-free areas may provide additional useful information for identifying patients who may be at risk of developing both PAP and CPAP, which may be beneficial in enabling stratification in the perioperative period of patients based on individual vulnerabilities to avoid/reduce this complication.

Teres Intermedius: An Accessory Rotator Cuff Muscle Discovered During Routine Cadaveric Dissection

The teres minor is a unipennate intrinsic shoulder muscle that arises on the lateral border of the scapula and runs obliquely to insert on the greater tubercle of the humerus. It stabilizes and contributes to external rotation of the glenohumeral joint. Teres major, while resembling the teres minor in origin and fiber direction, ultimately diverges from the teres minor as it passes anterior to the humerus and acts predominantly as a medial rotator and adductor of the shoulder. Described variants in the teres musculature are rare. We found a unilateral accessory muscle in the teres region of the right shoulder in an 81‐year‐old Caucasian male cadaver in a traditional anatomy lab. The accessory muscle arises from the lateral aspect of the scapula and travels parallel and posterior to the teres minor to insert onto the posterior head of the deltoid. The variant muscle is of similar size to the teres minor (also present), but its fibers are encapsulated in their own distinct fascial sheath, entirely separate from that of the anatomically normal teres muscles. We provide a detailed description of the accessory muscle and propose that similar variants may be clinically important due to their proximity to the anatomical quadrangular space, as compression of the structures traversing this area may result in pain, tenderness, paresthesia, and cyanosis in the shoulder region.

A Rare Case of Unresectable Solitary Extramedullary Plasmacytoma at the Shoulder Region: Case Report

INTRODUCTION: Plasmacytoma is a solitary neoplastic lesion marked by a localized accumulation of monoclonal plasma cells without an evidence of a systemic proliferation. Plasmacytoma may arise in intramedullar (bone) or extramedullar (soft tissue). Extramedullary plasmacytoma is rare, with the most frequent locations in the nasal cavity and nasopharynx. Here, we describe a case of solitary extramedullary plasmacytoma of the shoulder region. CASE REPORT: A 49-year-old male patient presented with right shoulder mass that was solid, fixed, ulcerated, and poorly circumscribed, with size 20 × 15 × 10 cm. Shoulder X-ray and MRI results revealed a soft-tissue mass on the right shoulder with the destruction of lateral part of the right clavicle. Biopsy results suggested Non-Hodgkin Lymphoma; however, first panel of immunohistochemical (IHC) analysis showed negative staining of LCA, CK, CD20, and CD3, with high Ki67. Second panel of IHC revealed negative staining of ALK, TdT, and CD79a; meanwhile, CD138 was strongly expressed. Further hematological, biochemical, and radiological examinations that revealed no systemic involvement supported the diagnosis of solitary extramedullary plasmacytoma. Patient received radiotherapy treatment 60 Gy in 30 fractions and zometa within 4 weeks interval and showed remarkable response of the therapy. DISCUSSION: Solitary extramedullary (soft tissue) plasmacytomas (SEP) are less common than solitary bone plasmacytoma (SBP), yet it has a better prognosis since the majority can be cured by local radiotherapy. CONCLUSION: We report a case of SEP of the shoulder that showed remarkable response of therapy. In this case report, radiotherapy was shown to be a highly effective modality to treat a patient with solitary extramedullary plasmacytoma.

Sub-micrometer morphology of human atherosclerotic plaque revealed by synchrotron radiation-based μCT—A comparison with histology

Histology is a long standing and well-established gold standard for pathological characterizations. In recent years however, synchrotron radiation-based micro-computed tomography (SRμCT) has become a tool for extending the imaging of two-dimensional thin sections into three-dimensional imaging of tissue blocks, enabling so-called virtual histology with arbitrary clipping planes, volumetric rendering and automatic segmentation. In this study, we present a thorough characterization of human carotid plaques after endarterectomy of patients with stroke or transient ischemic attack (TIA), investigating several different pathologic structures using both SRμCT and histology. Phase-contrast SRμCT was performed with two different magnifications (voxel sizes 6.5 μm and 0.65 μm, respectively), and histology was performed with multiple different stainings (Alpha-actin, Glycophorin A, von Kossa, Movat, CD68). The 0.65 μm high-resolution SRμCT was performed on selected areas with plaque typical relevant morphology, identified on the 6.5 μm low-resolution SRμCT. The tomography datasets were reconstructed with additional 3D volume rendering and compared to histology. In total, nine different regions with typical pathologic structures were identified and imaged with high-resolution SRμCT. The results show many characteristics typical for advanced atherosclerotic plaques, clinically relevant, namely ruptures with thrombosis, neo-vascularization, inflammatory infiltrates in shoulder regions, lipid rich necrotic cores (LRNC), thin fibrous cap, calcifications, lumen irregularities, and changes in vessel wall structures such as the internal elastic membrane. This method’s non-destructive nature renders details of micro-structures with an excellent visual likeness to histology, with the additional strength of multiplanar and 3D visualization and the possibility of multiple re-scans.

Active aspiration versus simple compression to remove residual gas from the abdominal cavity after laparoscopic cholecystectomy: a randomized clinical trial.

After laparoscopic surgical procedures, residual gas in the abdominal cavity can cause post-operative pain, which is commonly located in the shoulder region. Previous studies suggested that post-laparoscopy pain can be prevented by active suctioning of intraabdominal gas at the end of surgery. This randomized controlled trial (registered at DRKS 00,023,286) compared active suctioning versus manual compression in their ability to reduce pain after laparoscopic cholecystectomy. Patients scheduled for laparoscopic cholecystectomy were eligible for trial participation. The primary outcome measure was post-operative pain intensity after 12h. All the patients were examined by MRI scanning to quantify the intraabdominal gas volume after the intervention. As planned, 60 patients were recruited. The two groups (n = 30 each) were very similar at the end of surgery. Active suctioning reduced the amount of residual pneumoperitoneum more than simple compression (median volume 1.5 versus 3.0ml, p = 0.002). The primary outcome measure, abdominal pain after 12h, was slightly lower in the intervention group (- 0.5 points, 95% confidence interval + 0.5 to - 1.7), but without reaching statistical significance (p = 0.37). After 12h, shoulder pain was present in 10 patients in each group (p = 1.0). Independent of group assignment, however, residual gas volume was significantly associated with higher pain intensity. Active suctioning appears to have only a minor preventive effect on post-laparoscopy pain, probably because evacuation of the pneumoperitoneum remains incomplete in some patients. Other more effective maneuvers for gas removal should be preferred.

Identification of TALE Transcription Factor Family and Expression Patterns Related to Fruit Chloroplast Development in Tomato (Solanum lycopersicum L.).

The TALE gene family is an important transcription factor family that regulates meristem formation, organ morphogenesis, signal transduction, and fruit development. A total of 24 genes of the TALE family were identified and analyzed in tomato. The 24 SlTALE family members could be classified into five BELL subfamilies and four KNOX subfamilies. SlTALE genes were unevenly distributed on every tomato chromosome, lacked syntenic gene pairs, and had conserved structures but diverse regulatory functions. Promoter activity analysis showed that cis-elements responsive to light, phytohormone, developmental regulation, and environmental stress were enriched in the promoter of SlTALE genes, and the light response elements were the most abundant. An abundance of TF binding sites was also enriched in the promoter of SlTALE genes. Phenotype identification revealed that the green shoulder (GS) mutant fruits showed significantly enhanced chloroplast development and chlorophyll accumulation, and a significant increase of chlorophyll fluorescence parameters in the fruit shoulder region. Analysis of gene expression patterns indicated that six SlTALE genes were highly expressed in the GS fruit shoulder region, and four SlTALE genes were highly expressed in the parts with less-developed chloroplasts. The protein-protein interaction networks predicted interaction combinations among these SlTALE genes, especially between the BELL subfamilies and the KNOX subfamilies, indicating a complex regulatory network of these SlTALE genes in chloroplast development and green fruit shoulder formation. In conclusion, our result provides detailed knowledge of the SlTALE gene for functional research and the utilization of the TALE gene family in fruit quality improvement.

Effect of microstructural variation on strain localization in double‐sided friction stir welded AA6061‐AA7075 joints

AbstractIn friction stir welding (FSW), the inhomogeneous microstructure significantly affects the mechanical performance of the joints. The present study investigates the influence of microstructural asymmetry along the thickness on strain localization during tensile test using the digital image correlation technique and fracture morphology for double‐sided FSW (DS‐FSW) AA6061‐AA7075 joints. In top and bottom slices of the transverse tensile sample, nonhomogenous strain localization is noted in heat affected zone (HAZ) of the advancing side (AS), that is, AA6061‐T6, and also presents higher tensile strength. However, in the middle slice of the transverse sample, larger region including thermo‐mechanically affected zone and HAZ undergoes strain localization and exhibits higher elongation at failure. In longitudinal specimens, the strain distribution is homogeneous up to uniform elongation followed by strain concentration at a localised region and fracture. Electron backscatter diffraction revealed that the extent of dynamic recrystallization on the retreating side (AA7075‐T61) is higher than that observed on the AS of the weld. The grain orientation spread map showed a high fraction of recrystallized grains at the weld centre. Presence of major shear textures components and both below the tool shoulder and weld centre regions are observed from pole figures. The recrystallized texture components P ({011}&lt;112&gt;), Goss ({110}&lt;001&gt;), Rotated Goss ({110}&lt;110&gt;), Cube ({001}&lt;100&gt;) and shear texture ({001}&lt;110&gt;) components is also noted at the weld centre. Middle slice both for longitudinal and transverse sample showed the finest dimple size on the fracture surfaces. The strain localization behaviour and tensile performance assessed for transverse and longitudinal samples can be helpful to find the load orientation dependency and safe design of DS‐FSW joints.

Role of Traditional Therapy (Yoga) in Avabahuka (Frozen Shoulder)

Frozen shoulder, the “Peri-arthritis” or “Adhesive Capsulitis” is the problem of shoulder region in which the shoulder capsule, the connective tissue surrounding the gleno-humeral joint of shoulder, becomes inflamed and stiff, greatly restrict motion and cause chronic pain. In Ayurveda there is no direct reference of frozen shoulder. But there are many problems which are related viz “Avabahuka”, “Amsa Shosha”, “Bahushosha”, “Sandhigata Kupita Vata”, Snayu Gata Kupita Vata. Among these Avabahuka has close correlation with frozen shoulder. This disease usually affects the Amsa Sandhi (shoulder joint). Acharya Sushruta and other Acharyas have considered Avabahuka as a Vataja Vikara. Amsa Shosha (wasting of shoulder) can be considered as the preliminary stage of the disease, where loss or dryness of Shleshak kapha from Amsa Sandhi occurs and hampers the movement of the arm. The most common treatment for frozen shoulder is mobility, exercises and Yoga (Asana &amp; Pranayama). Yogic procedures are helpful in removing the stiffness of the joint. Keeping this in mind I am presenting a review article on following exercises (Suksham Vyayama- wrist movement, elbow movement, shoulder movement, neck movement, wall climbing exercise, towel stretch exercise, Chakkichalan), Asanas (Tadasana, Chakkichalanasana, Ardhakatichakrasana, Katichakrasana and Shashankasana) and Pranayama (Kapalbhati, Nadishodhana (Anulom-Vilom), Bhramari) how they help manage or prevent frozen shoulder.

The Relationship Between the NSP and the Individual and Work Organizational Variables: A Cross-Sectional Study.

ObjectivesTo investigate the characteristics of neck–shoulder pain (NSP) and explore the potentional relationship between the NSP and the individual and work organizational variables.MethodsA cross-sectional study was performed in the tertiary general hospitals in Hunan Province, China between May 2019 and July 2019. A total of 2,030 healthcare workers were enrolled randomly in this study based on a three-stage stratified sampling method. The Neck Disability Index (NDI) was used to measure disability in subjects with neck pain. A self-administered questionnaire was used to assess the characteristics of individual and work organizational variables. The Mann–Whitney U test and the Kruskal–Wallis H test were applied to analyze the prevalence of pain intensity among groups. Multivariate linear regression analysis was performed to explore the potentional relationship between NSP and individual and work organizational variables using the NDI score as the dependent variable.Results2,008 of 2,030 healthcare workers filled out the survey questionnaires online. In the past 12 months, 1,489 participants (74.2%) complained of pain in the cervical–shoulder region. NDI score increased by 0.10 for each year of age, with healthcare workers working in Obstetrics and Gynecology, and the Operating Room less likely to have NSP than those working in other departments. In contrast, female healthcare workers with a history of pregnancy were more likely to have NSP. In terms of organizational factors, workers who received concern from their supervisor about their health, who had the choice to change their shift status to off duty when they were not feeling well, or who were informed about WMSDs were less likely to have NSP.ConclusionThe prevalence of NSP within the previous year was high in this population. Individual factors including history of neck–shoulder diseases, age, and history of pregnancy and organizational factors including being adequately informed regarding WMSDs, concern from supervisors about workers' health, and the ability of workers to change their shift status to off duty when they were not feeling well were shown to induce significant effects to NSP.

A Cross-Sectional Descriptive Study of Musculoskeletal Disorders (MSDs) of Male Shipbuilding Workers and Factors Associated the Neck, Shoulder, Elbow, Low Back, or Knee MSDs

This study investigates the cross-sectional descriptive characteristics of male shipbuilding workers’ musculoskeletal disorders (MSDs) and factors associated with MSDs in the neck, shoulders, elbows, low back, or knees. From the national compensation data confirmed as MSDs during three years between 2015 and 2017, 985 male workers were analyzed in terms of age, work experience, occupations, company size, and MSD type according to each body region. In the analysis of frequency and severity according to ‘occupation–body region–MSD type’, ‘Electrician/plumber–low back–herniated disc’ (6.9%) was the form of MSDs with the highest frequency among total MSDs, and ‘Crane–neck–herniated disc’ (500.5 days) was the highest mean of sick leave days. The low back MSDs (28.9%) were the highest frequency, followed by shoulders (27.7%) and knees (16.2%). The herniated disc was frequent in the neck and lumbar region, and the mean of sick leave days of the neck herniated disc (402.2 days) was greater than that of the low back herniated disc (321.1 days). While a rupture was frequent in the shoulder or knee region, the mean of sick leave days for shoulder rupture (335.1 days) was greater than that of the knee rupture (318.8 days). In the binary logistic regression analysis, age was positively associated with MSDs in the neck, shoulder, or elbow regions, while the low back MSDs category was not positively associated with age. Large companies with &gt;1000 employees were highly associated with neck MSDs, while small companies with &lt;30 employees were related to the low back MSDs. This study derives the characteristics for frequency and sick leave days of MSDs in the neck, shoulders, elbows, low back, or knees to prioritize MSD prevention information. The results of this study can be used as primary data for establishing MSD prevention policy.