Side Bending Research Articles

Comparison of Standing Side Bending Using Biplanar Stereography and Fulcrum Bending for Flexibility Assessment of Adolescent Idiopathic Scoliosis.

Background: The surgical treatment of adolescent idiopathic scoliosis (AIS) is influenced by factors such as skeletal maturity, curve magnitude, progression, and spinal flexibility. The assessment of spinal flexibility is crucial for surgical planning; supine bending radiographs are commonly used but there is no consensus on the optimal technique. Fulcrum bending radiographs (FBRs) have shown better prediction of post-surgery correction compared to supine bending radiographs. New radiological techniques allow a significant reduction in radiation exposure. This study aims to compare spinal flexibility assessment and radiation exposure between FBRs and standing side-bending radiographs (SSRs) using biplanar stereoradiography. Materials and Methods: Twenty-five consecutive AIS patients scheduled for surgery were included in this prospective cohort study. Exclusion criteria were non-idiopathic etiology, age younger than 12 years, and older than 18 years. Pre-surgery FBRs and SSRs were performed, and the Cobb angles were measured. Flexibility and correction rates were calculated. Dose-area products (DAPs) were recorded. Statistical analysis was conducted using the Wilcoxon signed-rank test and Spearman correlation. Results: The mean pre-surgery Cobb angle of the thoracic curve was 66.3°. The FBR was superior to SSR for assessing flexibility for thoracic curves and provided a better prediction for post-surgery correction. There was no significant difference in lumbar curves between FBR and SSR. The mean DAP for SSRs was 0.81 Gy*cm2 compared to 3.42 Gy*cm2 for FBR, indicating a lower radiation exposure using SSRs. Conclusions: FBRs are superior for flexibility assessment of thoracic curves in AIS and offers a better prediction of post-surgery correction compared to SSRs. However, FBR is associated with a higher radiation exposure.

It doesn't hurt as long as I don't move: Aligning pain assessment in patients with rib fractures with mobilization needed for recovery.

Rib fracture pain is a major issue but likely underappreciated, given that patients avoid activity due to the pain. Pain is one criterion used to determine if someone is a candidate for surgical stabilization of rib fractures (SSRF). The purpose of this study was to assess pain for rib fracture patients, hypothesizing pain from rib fractures is underappreciated in current practice. A prospective study analyzing patients with one or more rib fractures admitted to our Level I trauma center from March 2023 through February 2024. Exclusion criteria included refusal to participate, ventilator dependent, younger than 18 years, moderate/severe traumatic brain injury, spinal cord injury, pregnancy, or incarceration. Basic demographics were obtained. Participants rated their pain on an 11-point Numerical Rating Scale while resting in bed and performing a series of movements (0, no pain; 10, worst pain imaginable). Movements included incentive spirometer, flexion, extension, bilateral side bending, bilateral rotation, and holding a 5-pound dumbbell. Patients undergoing SSRF were surveyed pre- and postoperatively. Outcomes included the difference between pain scores at rest versus performing all movements, difference between pain scores pre- and post-SSRF, and incentive spirometry pre- and postoperatively. Nonparametric analysis was completed with the Wilcoxon signed-rank test with statistical significance set at p < 0.05. One-hundred two patients were enrolled. The mean age was 60 ± 15 years; 57.8% were male. The median pain score at rest was 3 (interquartile range [IQR], 2-5.5). Pain scores significantly increased to >5 for all movements. Thirty-one patients underwent SSRF. Resting pain prior to SSRF was 3 (IQR, 1-6) and postoperatively was 2 (IQR, 1.5-3) (p = 0.446). For all movements, median Numerical Rating Scale score was significantly less after SSRF (p < 0.001). The median incentive spirometry was 1,100 mL (IQR, 625-1,600 mL) preoperatively and 2,000 mL (IQR, 1,475-2,250 mL) postoperatively. Traditional assessment of pain in patients with rib fractures significantly underappreciates true pain severity caused by movements involving the chest wall and should be considered when evaluating for SSRF. Therapeutic/Care Management; Level III.

Theoretical Study of Asymmetric Bending Force on Metal Deformation in Cold Rolling

A three-dimensional elastic–plastic finite element model of a six-roll cold rolling mill has been developed using the finite element software ABAQUS. The actual parameters of the rolling mill have been incorporated into the finite element model, with the working conditions applied as boundary constraints and load conditions. Subsequently, a non-symmetrical bending force is introduced to the finite element model. Through simulation calculations, this study analyzes the patterns of change in the transverse pressure of the rolling mill and roller pressure during non-symmetrical bending, as well as the variations in strip thickness, crown, edge drop, and flatness. Additionally, the regulating function of the bending force is examined. Each adjustment of 5 t in the asymmetric bending force results in an increase of approximately 0.01 mm in the thickness of the positive bending side of the strip while causing a decrease of about 0.01 mm in the thickness of the negative bending side. Therefore, the application of asymmetric bending forces proves to be effective in controlling the shape of lateral wave defects on the edges of steel strips.

Immediate effects of thoracic mobilization versus soft tissue release on trunk motion, pain, and lumbar muscle activity in patients with chronic low back pain

IntroductionThoracic mobilization and tissue release are common manual techniques in clinical practice. However, the relative effects of these two treatments on chronic low back pain (CLBP) have not yet been explored. Thus, this study aimed to investigate and compare the immediate effects of thoracic mobilization with those of soft tissue release on trunk movement, pain sensation, and muscle activity in patients with CLBP. Methods28 participants were randomly assigned to two intervention groups. The mobilization group received mobilization treatment at the hypomobile joints of the trunk segment, while the soft tissue release group received thoracolumbar fascia release and massage in the lumbar region. The trunk range of motion (ROM), tissue hardness, pressure pain threshold (PPT), and erector spinae activity during light-weight lifting tasks were measured before and immediately after both interventions. FindingsAll measured outcomes in both groups improved after intervention (p < 0.05). The mobilization technique significantly improved side bending and rotation, PPT, and tissue hardness compared to soft tissue release. However, lumbar muscle activation reduced to a greater extent in the soft-tissue release group. ConclusionBoth techniques improved trunk ROM and PPT and reduced tissue hardness and muscle activation. Therefore, both these techniques are recommended for patients with CLBP. Trial registrationISRCTN75190733.

القفاز الناطق الذكي بيد واحدة للصم و البكم

The sign language is an effective means of communication between the deaf and dumb communities and the general public, but it requires human translators. This paper describes the development of a smart speaking glove with one-hand deaf and Dumb individuals using Arabic sign language. The glove bridges the communication gap between those with hearing and speech problems and those who don't understand sign language. It accurately converts sign language motions into audio and text, enhancing dignity, independence, and social inclusion. The glove, made of flexible sensors and a six-dimensional motion tracking device, allows deaf individuals to communicate with regular people via a smartphone, reducing the gap between them. It has focused on six major scenarios based on sentences and words of foodstuff and welcome signs. In cooperation with the Zawia Center for the Deaf and Dumb, every scenario was evaluated. The glove performed well when tested for side bending, resistance, voltage, and angle.

Effectiveness of adding dry needling of the upper trapezius muscle to the usual physiotherapy for managing chronic neck pain: A randomized controlled trial with a 7-week follow-up

BackgroundMyofascial pain syndrome (MPS) is a chronic condition caused by sensitive pressure regions within the muscles known as myofascial trigger points (MTrPs). ObjectiveThe purpose of this randomized controlled trial (RCT) was to assess the effectiveness of adding dry needling (DN) to activate MTrPs in the upper trapezius muscle compared with usual physiotherapy among individuals with chronic neck pain. MethodsThirty participants were recruited from a private clinic in Saudi Arabia. Their mean age was 29.7 ± 4.4 years. The subjects were randomized into two groups: the experimental group (application of DN to the MTrPs coupled with usual physiotherapy (n = 15)) and the control group (usual physiotherapy alone (n = 15)). The primary outcomes were pain (assessed using the visual analog scale) and disability (Neck Disability Index), and the secondary outcomes were neck active range of motion (AROM; assessed using cervical ROM) and depression (Beck's Depression Inventory). ResultsSignificant between-group difference in pain intensity was observed immediately post-intervention. Participants in the experimental group had significantly higher pain (mean difference = 1.27, 95% confidence interval [CI] 0.20, 2.33, p = 0.022, Cohen's d = 0.889) than those in the control group. There was no significant difference between both groups in pain intensity during the follow-up. There were no between-group differences in disability immediately post-intervention. However, there was a between-group difference in disability at follow-up; participants in the experimental group had significantly lower disability (mean difference = −3.13, 95%CI -5.07, −1.20, p = 0.003, Cohen's d = 1.211) than those in the control group. Immediately post-intervention, the experimental group showed greater flexion AROM compared to the control group, with no differences in other AROM measures. At follow-up, the experimental group exhibited significantly higher neck AROM in extension, flexion, right and left side bending, and lower depression, while no differences were observed in right- and left-rotation AROMs between groups. ConclusionsThe addition of DN to standard physiotherapy effectively improved disability, AROM (extension, flexion, and side bending), and depression among patients with chronic neck pain.

Influence of dual axial magnetic field and welding parameters on weld characteristics in GTAW process

A methodology has been proposed that is capable of altering arc shape as per the requirement using an external magnetic field. Eight magnetic configurations were explored, out of which the N-S-S-N configuration yielded a wider bead width and lower penetration without any change in process parameters, which is more suitable for cladding and hard-facing applications. The central composite design technique has optimized the process parameters to achieve the maximum cladding width. Further, the effect of the selected configuration on the characteristics of claddings in terms of bonding strength, microhardness, and metallurgical properties have been investigated at optimal parameters. This investigation selected the SA 516 grade 70 as a substrate and SS 308 L as a cladding material. It was observed that bead width increases with increased excitation current and decreased travel speed. The maximum bead width (10.89 mm) was achieved at a 1.8 A excitation current and 1 mm/sec travel speed. The experiment has been conducted on the optimized value of process parameters to validate the developed model. A comparative study between magnetically controlled (MC-GTAW) and conventional GTAW processes. The result revealed that the MC-GTAW process has wider bead width (9.95 mm) and higher average hardness (391.45 HV), which is 67% and 15% more than that of the conventional GTAW process, respectively. The microstructure analysis has revealed that the MC-GTAW process yielded more granular bainite and refined grains. The claddings were subjected to a side bend test, which showed a good bonding strength between the substrate and the deposited metal.

The development of bend clamp of carbon-based fiber offshore gas lift pipelines: A primary experimental approach

The work reports the proposed development of the laminated carbon fiber-reinforced polymer composites (CFRP), at a uniaxial angle as a primary bend clamp material assembly of the offshore gas lift pipelines. Generally, the clamps are utilized to repair the defect of the metallic pipelines due to their practical and mechanical strength. The existing bend clamp model poses challenges especially when applied to the J-tube bending side due to mechanical buckling and corrosion. This study evaluates the effect of laminated CFRP subjected to uniform uniaxial and in-plane compression on API 5 L X52. Several tests, including tensile, bend, and impact tests, are chosen to assess the effect of multiple and thick carbon layers to improve the clamp's mechanical properties. Scanning electronic microscope (SEM) intends to reveal the surface characterization of carbon fiber clamp. The result shows that laminated carbon fiber increases the durability and mechanical properties of the bend clamp for two weeks. The tensile test result shows that the uniaxial orientation has the highest tensile strength of about 2000N and is affected by the strong interfacial bond between the fiber and metal layers. The high impact energy of 2242 ± 0.001 J of the same orientation shows the stability of the clamp under unprecedented dynamic load and enhances the safety. The SEM result at uniaxial shows the resistance towards fracture has increased and was initiated from the air pocket in the composite.

Short-term effect of acupuncture dry needle in treatment of chronic mechanical low back pain: a randomized controlled clinical trial.

In today's industrialized world, between sixty and ninety percent of the working-age population experiences low back discomfort. Chronic mechanical low back pain (CMLBP), the most common ailment among working-age people in contemporary industrial society, causes a major economic burden due to the widespread use of medical services and the absence of work. For those suffering from persistent mechanical low back pain, this experiment aimed to assess the efficacy of using acupuncture dry needles in the short term. Our research included 30 individuals with nonspecific low back pain; their ages varied from 20 to 45. The participants were divided into two parallel groups using a random process: 15 individuals in group A had acupuncture treatment with a dry needle placed to specified locations on their backs, whereas 15 individuals in group B participated in muscle strengthening and stretching exercises. Both before and after therapy, researchers examined the lumbar range of motion (ROM) in four directions: flexion, extension, bilateral side bending, as well as pain intensity and functional impairment. We examined the data for normality and covariance homogeneity using the Shapiro-Wilk and Box's tests, respectively. The variables of interest that were investigated were compared across various test groups and measurement periods using a 2x2 mixed design-multivariate analysis of variance (MANOVA). We used a significance threshold of 0.05. When comparing the two groups after treatment, it was found that the flexion and extension range of motion increased significantly (p<0.05), while the pain intensity, bending to the right and left, and functional impairment decreased significantly (p<0.05). The results of multiple pairwise comparisons showed a noteworthy difference in pain severity, functional debility, and back ROM between the two groups before and after treatment (p<0.05), with group A showing an advantage over group B after treatment. Based on the study results, dry needle acupuncture may be a beneficial modality in treating chronic mechanical low back pain by relieving pain intensity, improving functional debility, and improving ROM.

Motion Capture-based 3-dimensional Measurement of Range of Motion in Patients Undergoing Cervical Laminoplasty.

A prospective study. To measure 3-dimensional cervical range of motion (ROM) by noninvasive optical tracking-based motion-capture technology in patients undergoing laminoplasty, and to elucidate the postoperative effects of laminoplasty on cervical mobility. Cervical laminoplasty is a motion-sparing decompression surgery for degenerative cervical myelopathy. Unlike cervical laminectomy and fusion, the true postoperative impact of laminoplasty on neck motion has not been well studied. Participants comprised 25 patients undergoing double-door cervical laminoplasty for degenerative cervical myelopathy in a single center. Maximum flexion/extension, left/right rotation, and left/right side bending were recorded using the motion-capture device preoperatively and 3 months postoperatively. ROMs in 3 orthogonal axes were calculated. Preoperative differences in C2-7 Cobb angles on lateral flexion/extension x-rays were also measured as the radiologic ROM to assess reliability. Preoperative and 1-year postoperative Japanese Orthopaedic Association score, Neck Disability Index [NDI], and Euro-QOL were recorded, and correlations with ROMs were assessed. Preoperative mean (±SD) ROMs for flexion/extension, rotation, and side bending were 90±17, 107±16, and 53±17 degrees, respectively. Although radiologic sagittal ROM measurement showed a smaller range than motion capture, averaging 36±13 degrees, a moderate to strong correlation between radiologic and motion capture values was observed (R=0.57, P=0.003). Preoperative NDI showed a negative correlation with coronal ROM (rho=-0.547, P=0.02). Postoperative ROM showed a significant reduction in rotation (95±16 degrees, P=0.002) but not in flexion/extension or side bending. Three-dimensional motion-capture analysis allowed reliable measurement of cervical ROM. Rotational ROM was significantly reduced after laminoplasty, showing that cervical kinematics are still significantly altered.

Waste to wealth: development of cladding flux from steel slag for submerged arc welding

A novel methodology has been developed which permits to transform waste slag into welding flux meant for stainless steel cladding. The developed flux has been applied for stainless steel cladding using submerged arc welding process. The claddings prepared using developed flux has been evaluated in terms of bead geometry, mechanical properties and chemical composition. The depth of penetration, weld bead width and height of reinforcement achieved with developed flux are 7.64 mm, 14.01 mm, and 4.07 mm, respectively, which are superior than obtained with fresh flux (8.05 mm, 12.85 mm, and 3.44 mm), as far as cladding is concerned. It observed that the developed flux is capable to produce chemical composition of claddings as per ASME SFA 5.4 standard. The percentage of chromium, nickel and manganese in claddings is 18.1%, 8.56% and 1.04% respectively which satisfy the ASME requirements. The side bend test proves a good bonding strength between substrate and claddings. The hardness of claddings produced with developed flux is also comparable with that of fresh flux. The average hardness of cladding produced with developed flux is 459 Hv, compared with that of fresh flux (435 Hv). The cost of developed flux is 54.86% economical than that of fresh flux. This research advocates that steel slag could be utilized as a raw material for manufacturing welding flux for stainless steel cladding.

Trunk kinematic analysis of ascent and descent stairs in college students with idiopathic scoliosis: a case-control study

BACKGROUND CONTEXTTraditional 3D motion analysis typically considers the spine as a rigid entity. Nevertheless, previous single-joint models have proven inadequate in evaluating the movement across different spinal segments in patients with idiopathic scoliosis (IS). Scoliosis significantly impairs movement functions, especially during activities such as ascending and descending stairs. There is a lack of research on the patterns of stair movement specifically for patients with IS. PURPOSEThis study aims to investigate trunk kinematics in college students with IS during stair ascent and descent tasks. A total of 56 participants, 28 with IS and 28 with healthy controls, were recruited for this case-control study. The trunk movements were analyzed using a motion analysis system that incorporated a multisegment spine model. Understanding the multi-segment spine kinematics during stair tasks can contribute to the development of effective rehabilitation programs for individuals with IS. STUDY DESIGNCase-control study. SAMPLE SIZETwenty-eight IS and 28 controls. OUTCOME MEASURESCobb angle, spinal curvature, spinal active range of motion (ROM), Kinematics. METHODSThe Qualisys system (Gothenburg, Sweden) was utilized in this study with a sampling frequency of 150 Hz. It recorded the kinematics in the thoracic, lumbar, thoracic cage, and pelvis while ascending and descending stairs for both the 28 IS individuals and the 28 control participants. Additionally, clinical parameters such as the Cobb angle, curvature of the spine, spinal range of motion (ROM), and other relevant factors were concurrently assessed among the subjects. Project supported by the National Natural Science Foundation of China (Grant No. 82205306). The authors declare no conflict of interest in preparing this article. RESULTSThe findings of this study revealed that IS individuals exhibited reduced kyphotic curvature in the sagittal plane (p<.05) when compared to the control group. In contrast, these IS patients displayed greater coronal curvature (Cobb angle) in the frontal plane and a more substantial difference in thoracic side bending range of motion in comparison to the control group (p.05). Moreover, during the ascending stair activity, IS patients showed reduced thoracic cage flexion-extension range of motion (p<.05), while displaying increased lumbar rotation range of motion and anterior-posterior pelvic tilt range of motion (p<.05) in contrast to the control group. Notably, the kinematic analysis during the descent of stairs indicated that IS patients exhibited a larger range of motion in thoracic flexion-extension, thoracic side bending, thoracic cage side bending, thoracic rotation, and thoracic cage rotation when compared to the control group (p<.05). CONCLUSIONSThe results showed significant differences in trunk kinematics between the two groups during both stair ascent and descent tasks. The utilization of the "multisegment spine model" facilitates the acquisition of motion information across multiple segments of the spine in patients diagnosed with IS, effectively enhancing the assessment outcomes derived from imaging information. The three-dimensional structural deformity in the trunk affects both static and dynamic activity patterns. In different activity states, IS patients demonstrate stiff movements in certain segments while experiencing compensatory instability in others. In the future, clinical rehabilitation programs for IS should prioritize stair-related activity training.

Prediction of postoperative curve correction based on the supine radiographs for adult idiopathic scoliosis patients

BACKGROUND CONTEXTPreoperative supine radiographs are mandatory in the new adult idiopathic scoliosis (AdIS) classification. Supine radiographs are easily reproducible and highly predictive of side bending radiographs. However, few studies evaluated the use of supine radiographs in predicting postoperative curve correction after posterior spinal fusion (PSF) in AdIS. PURPOSETo investigate the use of supine and side bending (SB) radiographs in predicting postoperative curve correction in AdIS patients who underwent PSF. STUDY DESIGNRetrospective study. PATIENT SAMPLEA total of 93 AdIS patients who underwent PSF between 2022 and 2023 were included. OUTCOME MEASURESDemographic data were age, gender, height, weight, body mass index (BMI), Risser grade, Lenke curve types and Cobb angles. Main outcome measures were preoperative and immediate postoperative Cobb angle (proximal thoracic [PT], main thoracic [MT] and thoracolumbar/lumbar [TL/L] curves), Supine Cobb angle and Flexibility rate (PT, MT and TL/L), and Correction rate (PT, MT and TL/L). METHODSCorrelation study was performed between Supine Cobb angle vs postoperative Cobb angle for PT, MT and TL/L curves. A predictive formula was derived from the correlation plots. RESULTSA total of 93 subjects were included in our study with a median age of 24.7 years and comprised of 80 females (86.0%). Preoperative Supine Cobb angle (r=0.835, r=0.881, r=0.767, p<.001) and preoperative SB Cobb angle (r=0.815, r=0.872, r=0.801, p<.001) showed similar strong positive correlation with postoperative PT, MT and TL/L Cobb angle, but preoperative Supine Cobb angle had slightly stronger correlation in PT and MT, whereas preoperative SB Cobb angle had stronger correlation in TL/L curve. Using the derived predictive formulae, there was a significant, strong, positive correlation between the predicted value and actual value of postoperative standing Cobb angle, (r=0.852, p<.001), with 71.0% of the patients had predicted postoperative Cobb angle from the supine radiographs within 5° of the actual value. CONCLUSIONBoth supine radiographs and side bending radiographs had strong predictability of the postoperative Cobb angle for PT, MT and TL/L curves. In 71.0% of patients, the actual postoperative Cobb angle was within 5° of the predicted postoperative Cobb angle using the predictive formulae.

The Impact of Forward Head Posture on Neck and Ankle Joint Position Sense: A Cross-Sectional Study.

Forward head posture (FHP) decreases the neck position sense and creates tension in the neck muscles, which inversely affects the mechanics of the distal joints through body myofascia. Thus, this study investigated the effects of FHP on neck and ankle joint position sense, and conducted a comparison between the joint position sense of the right and left ankle. Fifty-seven subjects were assigned according to the craniovertebral angle (CVA) into the FHP group (CVA <49°; n = 27) or the control group (CVA >49°; n = 30). Head and ankle joint repositioning accuracy was measured by using a cervical range-of-motion device and an isokinetic dynamometer, respectively. There was a significant increase in the joint position error (JPE) of the cervical flexion, extension, and right and left side bending motions of the FHP group compared to the control group (P < .05). There were significant increases in the JPE of the right and left ankle dorsiflexion and plantarflexion of the FHP group compared to the healthy group (P < .05). Moreover, the JPE of the right ankle dorsiflexion and plantarflexion of the FHP group were significantly higher than the left ankle (P < .05). The FHP decreases the position sense of cervical flexion, extension, and right and left side bending motions, and the plantarflexion and dorsiflexion of both ankle joints, especially the right ankle joint.

Predicting radiographic outcomes of vertebral body tethering in adolescent idiopathic scoliosis patients using machine learning.

Anterior Vertebral Body Tethering (AVBT) is a growing alternative treatment for adolescent idiopathic scoliosis (AIS), offering an option besides spinal fusion. While AVBT aims to correct spinal deformity through growth correction, its outcomes have been mixed. To improve surgical outcomes, this study aimed to develop a machine learning-based tool to predict short- and midterm spinal curve correction in AIS patients who underwent AVBT surgery, using the most predictive clinical, radiographic, and surgical parameters. After institutional review board approval and based on inclusion criteria, 91 AIS patients who underwent AVBT surgery were selected from the Shriners Hospitals for Children, Philadelphia. For all patients, longitudinal standing (PA or AP, and lateral) and side bending spinal Radiographs were retrospectively obtained at six visits: preop and first standing, one year, two years, five years postop, and at the most recent follow-up. Demographic, radiographic, and surgical features associated with curve correction were collected. The sequential backward feature selection method was used to eliminate correlated features and to provide a rank-ordered list of the most predictive features of the AVBT correction. A Gradient Boosting Regressor (GBR) model was trained and tested using the selected features to predict the final correction of the curve in AIS patients. Eleven most predictive features were identified. The GBR model predicted the final Cobb angle with an average error of 6.3 ± 5.6 degrees. The model also provided a prediction interval, where 84% of the actual values were within the 90% prediction interval. A list of the most predictive features for AVBT curve correction was provided. The GBR model, trained on these features, predicted the final curve magnitude with a clinically acceptable margin of error. This model can be used as a clinical tool to plan AVBT surgical parameters and improve outcomes.

EFFECTS OF CERVICAL MUSCLES STRENGTHENING WITH AND WITHOUT SHOULDER EXERCISES IN POST-MASTECTOMY PATIENTS WITH NECK PAIN

Background of the Study: To compare the effects of cervical muscles strengthening with and without shoulder exercises on post- mastectomy patients with neck pain. Methodology: It was a randomized clinical trial, conducted in physical therapy department of a clinical setting through Dynamometer. Sample size of 24 patients were taken. Non-probability convenience sampling technique was used. A written consent form was taken from patients meeting inclusion criteria and were randomly allocated. In one group, patients were treated with cervical Muscles strengthening with shoulder exercises. In other group, patients were treated with cervical Muscles strengthening alone. Treatment was given once a day for three weeks. Muscle strength was examined using dynamometer, Baseline data was taken before treatment on first day after inclusion in study and again on the last day after treatment. SPSS 25 was used to analyze the data. Results: Wilcoxon signed rank test was used to compare individuals within the group which showed significant results in both groups, p-value 0.000 (i.e. &lt;0.001) for neck strength. Between groups comparison was done using Mann-Whitney U Test and it showed no significant changes for cervical extensors (p- value;0.143) , cervical side bending (right) (p-value; 0.315) and cervical side bending (left) (p-value; 0.853) strength differences, but however cervical flexors strength showed statistically significant results as p-value was 0.003. Conclusion: It was concluded that Cervical strengthening along with shoulder Rehabilitation can help improve the strength of cervical flexors. However, both the groups have equally resulted in improved cervical extensor, Side bending right and left strength. Keywords: Cervical, mastectomy, muscle strength, rehabilitation, exercises, therapeutic.

Parametric Investigation of Pelton Turbine Injector under Hydro-abrasive Erosion Conditions

In high-head Pelton turbines, the injector faces severe erosion due to suspended sediment leading to a reduction in turbine efficiency and higher maintenance costs. Here, the effects of design parameters such as the bend angle of the nozzle pipe, nozzle angle, and needle angle along with an operating parameter stroke ratio on hydro-abrasive erosion of Pelton turbine injector are numerically investigated. The Volume of Fluid (VOF) model was implemented for capturing the interphase between air and water; whereas, the SST k-ω model is used for modelling the turbulence effect. For tracking the discrete phase, a Eulerian-Lagrangian based Discrete Phase Model (DPM) is considered. The bend angles led to flow circulations in the nozzle pipe causing the non-uniform distribution of sediment concentration and uneven erosion patterns. Irrespective of the bend angle, the erosion hotspot in the needle is observed toward the bend side. Further, for larger sediment particles, higher bend angles lead to more erosion rate in both the nozzle and needle and must be avoided to prevent excessive damage. As the needle angle increases from 40° to 60° for a constant nozzle angle, the nozzle erosion rate increases by 70% and the needle erosion rate decreases by 99%. Hence, an injector design can be optimized in hydro-abrasive erosion conditions by selecting a needle angle between 40° and 60°. Further, the operation of the injector at too high and low a stroke ratio results in excessive erosion of the nozzle and needle, respectively. In this study, a stroke ratio of 0.45 is found to be the most suitable for hydro-abrasive erosion conditions. Moreover, the asymmetricity in the erosion pattern of the needle increases with needle angle and stroke ratio resulting in jet quality degradation, one major reason for efficiency reduction in Pelton turbines.

Erratum: Comparison of standing side bending and awake supine manual traction dynamic radiographs for predicting spinal flexibility with postoperative correction rate in adolescent idiopathic scoliosis

Erratum: Comparison of standing side bending and awake supine manual traction dynamic radiographs for predicting spinal flexibility with postoperative correction rate in adolescent idiopathic scoliosis

Numerical solution for the laterally loaded rigid piles considering resisting force and moment under combined loadings

A numerical method is first proposed for the response of laterally loaded rigid piles under lateral load based on the curved strain wedge model. The influence of shear displacement of the pile, resistance bending moment caused by the uneven vertical shear stress on the pile side and resistance force and bending moment at the pile bottom are all considered. The effect of the vertical load on the lateral response of the monopile foundation is then analyzed according to the practical fact that the piles are always subjected to combined loads. The vertical friction force on the pile side is derived by combining vertical load and horizontal bending of the pile, and the resistance force at the pile bottom is determined by both vertical load and pile self–weight. The effect of P–Δ on the pile foundation caused by the vertical load is also considered. Several field tests are used to verify the reasonableness and accuracy of the proposed method. The influencing factors are studied. The results show that the vertical load has a favorable effect on the lateral response of the pile in frictional soil and almost no effect on the lateral response of the pile in frictionless soil.

Finite Element Modeling for Biomechanical Comparisons of Multilevel Transforaminal, Posterior, and Lateral Lumbar Approaches to Interbody Fusion Augmented with Posterior Instrumentation

ObjectiveVerifying the intervertebral stability of each intervertebral fusion procedure, including transforaminal, posterior, and lateral lumbar interbody fusion (TLIF, PLIF, and LLIF, respectively), and the ratio of stress on the rods and pedicle screws during initial fixation may help select a fixation procedure that reduces the risk of mechanical complications, including rod fracture and screw loosening. Thus, we aimed to assess whether these procedures could prevent mechanical complications. MethodsUsing the finite element method (FEM), we designed four surgical models constructed from L2-5 as follows: posterior lumbar fusion (PLF), TLIF, PLIF, and LLIF models. Bilateral rods and each pedicle screw stress were tracked and calculated as Von Mises stress (VMS) for comparison among the PLF and other three interbody fusion models during flexion, extension, and side-bending movements. ResultsThe lowest rod VMS was LLIF, followed by PLIF, TLIF, and PLF in flexion and side bending movements. Compared with PLF, intervertebral fixation significantly reduced stress on the rods. No remarkable differences were observed in extension movements in each surgical procedure. A tendency for higher pedicle screw VMS was noted at the proximal and distal ends of the fixation ranges, including L2 and L5 screws for each procedure in all motions. Intervertebral fixation significantly reduced stress on the L2 and L5 screws, particularly in LLIF. ConclusionsStress on the rods and pedicle screws in the LLIF model was the lowest compared with that induced by other intervertebral fusion procedures. Therefore, LLIF may reduce mechanical complications occurrence, including rod fracture and screw loosening.