Brain and muscle activation patterns during postural control affect static postural control

BackgroundPrevious studies have reported existence of coordinated brain and muscle activity patterns that affect postural control. However, differences in these activity patterns that affect postural control are still unclear. The purpose of this study was to clarify brain and muscle activity pattern affecting postural control.Research questionDoes the difference in brain and muscle activity patterns during postural control affect postural control ability?MethodNineteen healthy men (mean age: 24.8 ± 4.1 years, height: 171.8 ± 5.5 cm, and weight: 63.5 ± 12.5 kg) performed a postural control task on a balance board, and their brain and muscle activities and body sway during the task were measured using functional near-infrared spectroscopy, surface electromyography, and three-dimensional accelerometry. Hierarchical cluster analysis was conducted to extract subgroups based on brain and muscle activities and postural control, and correlation analysis was performed to investigate the relationship between brain activity, muscle activity, and postural control.ResultsTwo subgroups were found. Subgroup 1 (n = 9) showed higher brain activity in the supplementary motor area (p = 0.04), primary motor cortex (p = 0.04) and stable postural control in the mediolateral (p < 0.01) planes, and subgroup 2 (n = 10) showed higher muscle activity in the tibialis anterior (p < 0.01), a higher shank muscles co-contraction (p = 0.02) and unstable postural control. Furthermore, the supplementary motor area activity is negatively correlated with body sway of mediolateral plane (r = −0.51, p = 0.02), and tibialis anterior activity is positively correlated with body sway on the mediolateral plane (r = 0.62, p = 0.004).SignificanceHigher brain activity in motor-related areas, lower activity in the lower limb muscles and lower co-contraction of shank muscles were observed in stable postural control. These results will facilitate the planning of new rehabilitation methods for improving postural control ability.     

Uterine Artery Embolization following Cesarean Delivery but prior to Hysterectomy in the Management of Patients with Invasive Placenta

PurposeTo evaluate outcomes of patients with placenta accreta spectrum (PAS) disorders who underwent uterine artery embolization (UAE) following cesarean delivery but before hysterectomy.Materials and MethodsA retrospective review of patients with PAS treated with cesarean-hysterectomy (C-hyst) was performed. Patients in the UAE group underwent UAE after cesarean delivery but before hysterectomy; patients in the control group underwent C-hyst alone. Estimated blood loss (EBL), transfusion requirements, length of intensive care unit (ICU) stay, and adverse events were evaluated.ResultsThe study included 31 patients, 7 in the UAE group and 24 in the control group. Median EBL, transfusion requirements, and length of ICU stay in the UAE group compared with control group were 1,500 mL (range, 500–2,000 mL) vs 2,000 mL (range, 1,000–4,500 mL) (P = .04), 150 mL (range, 0–650 mL) vs 550 mL (range, 0–3,125 mL) (P = .10), and 0 d (range, 0–1 d) vs 0.5 d (range, 0–2 d) (P = .07). All patients in the UAE group had placenta increta; patients in the control group had placenta accreta (29%), increta (54%), and percreta (17%) (P = .10). Subgroup analysis of patients with placenta increta demonstrated that the UAE group had a significant decrease in median EBL (P = .004), transfusion requirements (P = .009), and length of ICU stay (P = .04). No adverse events following UAE were noted.ConclusionsUAE following cesarean delivery but before hysterectomy in patients with placenta increta appears to be safe and effective in decreasing EBL, transfusion requirements, and length of ICU stay compared with C-hyst alone.     

Improvement of lower-extremity stability by rotational leg press training

BackgroundsPrevious reports revealed that balance and stability are essential for human physical activity. The present study aimed to evaluate the comparative outcome of a novel beginning movement load training (BMLT) versus conventional leg press training in terms of improvement of lower-extremity stability.Research questionDoes the leg press training improve the stability of lower extremities?MethodsTwenty adult, asymptomatic and active amateur basketball players were enrolled in this study and randomized in equal numbers into a BMLT group (study group) and a conventional leg press training group (control group).ResultsThe results after eight-week course of training showed that conventional leg press training had an opposite effect on dynamic stability in the left leg (p = 0.015) and backward movement of the right leg (p = 0.038). The athletes in the study group revealed superior dynamic stability maintenance in both legs backwards (p = 0.001), the left leg (p = 0.013), the right leg backwards (p = 0.022) and overall stability (p = 0.002).SignificanceThe study group showed better postural stability in terms of the medial/lateral index (p = 0.017), and the athletes in the control group exhibited a significant inability to maintain postural stability in the medial/lateral aspect after the training (p = 0.016). Rotational BMLT lower-extremity press training yielded superior enhancement of dynamic stability and maintenance of center of gravity and postural stability.     

Copers adopt an altered dynamic postural control compared to individuals with chronic ankle instability and controls in unanticipated single-leg landing

BackgroundSeveral prior studies involving “expected” single-leg landings have not succeeded in establishing a difference between copers and a control group.Research questionDoes expected and unanticipated single-leg landing affect dynamic postural stability in lateral ankle sprain individuals with chronic ankle instability (CAI), copers, and controls?MethodsIn this prospective cross-sectional study, physically active adults with CAI (n = 12), copers (n = 12), and controls (n = 12) were included. Participants performed expected single-leg landing by stepping off a 30-cm box. They also performed unanticipated landings including side-step cutting, side-step cutting at 60°, single-leg landing, and forward stepping. The expected and unanticipated conditions of each groups were compared in terms of time to stabilization (TTS) and center of pressure (COP) for the anterior-posterior (AP) and medial-lateral (ML) conditions. To analyze the data, a mixed-model one-way analysis of variance and a Tukey-Kramer post hoc test were performed.ResultsA significant condition × group interaction was observed in only TTS ML, with the CAI group demonstrating a significantly longer TTS ML than the coper (p < 0.001) and control (p < 0.001) groups during unanticipated trials. In addition, group interaction effects were observed for COP AP and TTS AP. The coper group demonstrated significantly longer COP AP and TTS AP than the control group (p < 0.001).SignificanceThe CAI group demonstrated a significantly longer TTS ML than the coper and control groups during the unanticipated condition, and the coper group demonstrated significantly longer TTS AP and COP AP than the control group. Thus, longer COP AP and TTS AP sway time in the coper group may be a protection mechanism, allowing greater freedom in the AP plane while quickly controlling ML sway and preventing lateral ankle sprains. These findings can help in the prevention of lateral ankle sprains and assessment of dynamic postural control.     

The effect of latin dance on dynamic balance

BackgroundFigures and movements in Latin dance are effectively used to provide posture stabilization and balance control. A Computerized Dynamic Posturography can be used to complete a functional evaluation of postural control and stability in static and dynamic conditions, mediated by the interaction between the visual, vestibular, and somatosensory systems.Research QuestionAccording to the results of Computerized Dynamic Posturography, do dancers have better postural control and stability when compared to non-dancers, and can dance activity be recommended for vestibular rehabilitation?Material and methodsOur study included 26 professional Latin dancers and 26 non-dancers as a control group whoboth had no problems with their hearing or balance. Pure-tone audiometry and Computerized Dynamic Posturography tests were applied to the participants. The test results for the professional dancers and the control group were compared and evaluated. In statistical analysis, the Mann-Whitney U and Independent Samples T tests were used. A value of p < 0.05 was accepted for significance.ResultsAccording to the results of the Computerized Dynamic Posturography, the dancers generally performed better than the control group. While statistically significant and better performances were observed in dancers in terms of the composite balance, visual and vestibular scores within the scope of the Sensory Organization Test (p < 0.05), no statistically significant difference was found for somatosensory and preference scores (p > 0.05). Also, significant differences were obtained between the two groups in some subtests of Adaptation, Unilateral Stance and Limits of Stability assessment (p < 0.05). No significant difference was observed in Rhythmic Weight Shift results (p > 0.05).ImportanceThe results of thisresearch demonstrate that balance and posture improve through dance. Therefore, adding appropriate dance activities to vestibular rehabilitation programmes might be helpful.     

Atypical adaptive postural responses in children with developmental coordination disorder: Implications for rehabilitation

BackgroundAdaptive postural control is an important yet underexamined area in children with developmental coordination disorder (DCD). This study compared adaptive postural responses between children with DCD and those with typical development.MethodsThis was an exploratory cross-sectional study. Fifty-two children with DCD (aged 6–9 years) and 52 age- and sex-matched children with typical development participated in the study. Their adaptive postural (motor) responses were assessed using the Adaptation Test (ADT) on a computerized dynamic posturography machine. The sway energy score (SES) for each ADT trial and the average SES of five trials for both toes-up and toes-down platform inclination conditions were recorded.ResultsThe SESs were lower in the DCD group than in the control group in ADT toes-up trial 1 (p = 0.009) and on average (p = 0.044). In the control group, the SES decreased from trial 1 to trial 2 for both the ADT toes-up (p = 0.005) and toes-down conditions (p < 0.001).SignificanceAdaptive postural responses were absent in children with DCD, and these children used less force (i.e., sway energy) to overcome postural instability. Therefore, both adaptive balance and neuromuscular training should be factored into rehabilitation programs for children with DCD.     

Coper has altered foot joint coordination pattern compared to individuals with chronic ankle instability during running

BackgroundThere is limited information regarding the cause for the different etiologies in individuals with initial lateral ankle sprains (LAS) who have chronic ankle instability (CAI) and no recurrence or instability for > 12 months (copers) following initial LAS. Assessing the movement patterns of copers and individuals with CAI and LAS recurrence is essential for identifying the mechanical factors that affect patient outcomes.Research questionDoes coordination and coordination variability of rearfoot, midfoot, and forefoot present a potentially causative pattern for CAI or coper?MethodsThis cross-sectional study included 35 males who were divided into the CAI (n = 13), coper (n = 12), and control group (n = 10). Participants performed rearfoot strike running on the treadmill at a fixed speed of 3.5 m/s. The coupling angle between the rearfoot, midfoot, and forefoot, representing intersegmental coordination, was calculated using the modified vector coding technique and categorized into four coordination patterns. The coupling angle standard deviation served represented coordination variability during the stance phase.ResultsOne control participant and one CAI participant were excluded, and final analyses were performed on the CAI (n = 12), coper (n = 12), and control (n = 9) groups. During late stance, the coper group showed a significantly greater proportion of in-phase with distal dominancy (p = 0.02, effect size=0.17) and a significantly lower proportion of in-phase with proximal dominancy (p = 0.05, effect size=0.17), than the CAI group. During the early stance, the coper group showed a significantly lower proportion of anti-phase with distal dominancy than the CAI group (p = 0.03, effect size=0.18). There were no differences in intra-foot variability among the groups.SignificanceThe intra-foot coordination observed in the coper group suggests that this movement pattern may reduce the risk of ankle sprains.     

Transcatheter Arterial Embolization in the Management of Postpartum Hemorrhage due to Genital Tract Injury after Vaginal Delivery

PurposeTo evaluate efficacy and safety of transcatheter arterial embolization (TAE) in managing postpartum hemorrhage (PPH) due to genital tract injury after vaginal delivery and to investigate factors associated with outcome of TAE.Materials and MethodsA retrospective review of 43 women (mean age, 32.6 years) who underwent TAE to manage PPH secondary to genital tract injury after vaginal delivery was performed at a single institution between January 2007 and December 2018. Clinical data and outcomes were obtained. Patients were classified into clinical success (n = 39) and failure (n = 4) groups, and comparisons between the groups were performed.ResultsThe clinical success rate of TAE for PPH due to genital tract injury was 90.7%. In the clinical failure group, transfusion volumes were higher (failure vs success: packed red blood cells, 14 pt ± 3.37 vs 6.26 pt ± 4.52, P = .003; platelets, 10.33 pt ± 4.04 vs 2.92 pt ± 6.15, P = .036); hemoglobin levels before the procedure were lower (failure vs success: 7.3 g/dL vs 10.7, P = .016). Periprocedural complications included pulmonary edema (25.6%), fever (23.3%), and pain (9.3%). Twenty-four patients were either followed for > 6 months or answered a telephone survey; 23 (95.8%) recovered regular menstruation, and pregnancy was confirmed in 11 (45.8%). Regarding fertility desires, 7 women attempted to conceive, 6 of whom (85.7%) became pregnant.ConclusionsTAE is an effective and safe method for managing PPH due to genital tract injury after vaginal delivery. Lower hemoglobin levels before the procedure and higher transfusion volumes were associated with clinical failure of TAE.     

The relationship between forward head posture,postural control and gait: A systematic review

BackgroundForward head posture (FHP) is a common postural deviation. An increasing number of studies have reported that people with FHP present with impaired postural control and gait; however, there is conflicting evidence. A systematic review focusing on these relationships has been unavailable to date.Research questionIs there a relationship between FHP, postural control and gait?MethodsThis systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (PROSPERO ID: CRD42021231908). Web of Science, PubMed, Scopus, and CINAHL Plus (via EBSCO) were systematically searched, and a manual search was performed using the reference lists of included studies. Eligible studies included observational studies addressing the relationship between FHP, postural control and/or gait. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies.ResultsNineteen studies were selected for this review. Consistent evidence supported that people with FHP had significant alterations in limits of stability (n = 3), performance-based balance (n = 3), and cervical proprioception (n = 4). Controversial evidence existed for a relationship of FHP with static balance (n = 4) and postural stability control (n = 4). Limited evidence existed to support an alteration in gait and vestibular function. Three studies on induced FHP consistently identified no reduced postural control.SignificanceCurrent evidence supports an association between FHP and a detrimental alteration in limits of stability, performance-based balance, and cervical proprioception. Instead of simply indicating impaired overall balance, the findings of this review indicate that a reduction in specific aspects of the postural control requires to be clarified in clinical evaluation for individuals with FHP, which would facilitate the planning and application of appropriate interventions to prevent dysfunctions and disability.     

The effect of a digital training tool to aid chest image interpretation: Hybridising eye tracking technology and a decision support tool

IntroductionEye tracking technology, checklists and search strategies have been demonstrated as useful aids in image interpretation. A training tool was developed, by the research team, which included these features. This study aimed to evaluate the effect of the training tool on participant image interpretation performance.MethodsThe study was carried out with reporting radiographers who had either commenced training in chest image interpretation (n = 12) or were trained in musculoskeletal image interpretation (n = 23) (total n = 35). Participants were allocated to a control or intervention group. Participants completed an initial assessment at recruitment and re-attended nine months later for a follow-up assessment. The intervention group were given unlimited access to a digital training tool.During assessments participants interpreted 20 chest images whilst using eye tracking technology (total of 1400 images were interpreted). A confidence level was obtained from participants on their diagnosis and a questionnaire, to obtain demographic data, was completed following the assessment.ResultsImprovements were seen in the confidence of intervention group participants (p < 0.05). False Positive (FP) scores decreased for both the control and intervention group (p < 0.05), this decrease was from 4.20 to 3.20 for the control group and from 5.87 to 3.27 for the intervention group. True Negative (TN) scores increased, from 5.13 to 6.73 for the intervention group (p < 0.05). Mean decision time decreased for both the control and intervention group.ConclusionThe tool led to positive effects on participant performance and could be a useful aid in chest image interpretation learning.Implications for practiceImprovements in performance were observed with a digital tool. The tool could improve image interpretation methods and training.     

Impaired static postural control correlates to the contraction ability of trunk muscle in young adults with chronic non-specific low back pain: A cross-sectional study

IntroductionPatients with chronic non-specific low back pain (CNSLBP) were found with impaired postural control in previous studies. Since the trunk muscle take important efforts on core stability, the study aimed to examine the relationships of postural control during stance tasks and the contractility of trunk muscle in young adults with CNSLBP and without.MethodsHealthy individuals (n = 25) and individuals with CNSLBP (n = 30) were included. The thickness of the bilateral transversus abdominis (TrA) and lumbar multifidus (MF) was measured during rest and maximal voluntary contraction, and the change percentages (TrA%, MF%) were calculated. Regarding postural control, COP path length and sway area during the stance tasks were measured thrice in each group.ResultsThe bilateral TrA% of the CNSLBP group was less than that of the HC group (p < 0.05). The bilateral TrA% of the CNSLBP group was less than that of the HC group (p < 0.05). The bilateral MF% showed no significantly different(p > 0.05) between the two groups. Compared with healthy controls, CNSLBP patients resulted larger path length and sway area of COP during most of static stance tasks. During the EO task in the CNSLBP group, TrA% was found correlate to COP path length (p < 0.05); the right MF% was correlated with COP sway area (p < 0.05). No significant correlations appeared in the healthy controls (p > 0.05).ConclusionsCompared with healthy individuals, impaired postural control during static stance with eyes open in patients with CNSLBP was likely to be related to the poor contraction ability of bilateral transversus abdominis and correlated to the normal contraction ability of right lumbar multifidus.     

Evaluation of postural control in children with increased femoral anteversion

BackgroundFemoral anteversion is defined as the angular difference between the axis of the femoral neck and the transcondylar axis of the knee and the most common cause of an in-toe gait in children.Research questionDoes increased femoral anteversion (IFA) adversely affect postural stability and balance in healthy children?MethodsSixteen children with IFA aged 10–15 years and an age-matched control group of 16 children who were growing typically were included. Postural stability (PS), limits of stability (LoS), and the modified clinical test of sensory integration of balance (mCTSIB) were used to evaluate postural control by "Biodex Balance System® (BBS)" and Balance Error Scoring System (BESS), which is a visual observation of instability in 3 stance positions under 6 different conditions, were performed for all cases. SPSS v.20 program was used for data analysis. Independent Samples T-test or Mann Whitney U test were used for between-group comparisons depending on the distribution properties of the data. The significance level was set at p < 0.05.ResultsA significant difference was found between the groups for overall and anterior/posterior stability index in PS (p < 0.05), all parameters of LoS (p < 0.05) and mCTSIB (p < 0.05). Also there was a significant difference between the BESS firm surface (p = 0.007), BESS foam surface (p < 0.001), and total surface scores (p < 0.001).SignificanceThe results indicate that the children with IFA were significantly more unstable in all parameters of BBS and BESS when compared to their healthy peers. This shows that postural stability and balance are impaired in healthy children with IFA. To the extent of our knowledge, this study is the first to examine the postural control problems associated with IFA in healthy children.     

The effects of stroboscopic balance training on cortical activities in athletes with chronic ankle instability

ObjectivesTo investigate the effect of a 6-week stroboscopic balance training program on cortical activities in athletes with chronic ankle instability.DesignRandomized controlled trial. Setting: Single-center.ParticipantsThirty-nine participants were assigned to the strobe group (SG, n = 13), non-strobe group (NSG, n = 13), and control group (CG, n = 13).Main outcome measuresCortical activity and balance velocity were evaluated while the athletes were on the HUBER balance device. Electroencephalographic measurements of cortical activity were made at the transition from bipedal stance to single-leg stance.ResultsThe SG showed significant increases in Cz theta and alpha values and COP-v (center of pressure velocity) between pretest and posttest (p < 0.001, p = 0.003, p < 0.001). Posttest Cz theta was significantly higher in the SG compared to the CG (p = 0.009) and posttest Cz alpha was significantly higher in the SG compared to the NSG (p = 0.039) and CG (p = 0.001). Posttest COP-v was significantly higher in the SG than in the CG (p = 0.031) and NSG (p = 0.03).ConclusionsStroboscopic training may be clinically beneficial to improve balance parameters in athletes with CAI, and may have utility in sport-specific activity phases of rehabilitation to reduce visual input and increase motor control.     

Ankle muscle activation during the limits of stability test in subjects with chronic ankle instability

ObjectiveTo study postural control and muscle activity during the limit of stability test (LOS) in subjects with chronic ankle instability.DesignObservational study.SettingUniversity laboratory.Participants10 healthy subjects were included in the control group and 10 subjects in the CAI group (age between 18 and 30 years, with history of the multiple ankle “giving way” episodes in the last six months and score ≤24 in the Cumberland Ankle Instability Tool).Main outcome measuresA computerized dynamic posturography equipment was used for assessing the LOS. The electromyography activity of tibialis anterior (TA), soleus (SOL), medial gastrocnemius (MG) and peroneus longus (PL) was registered.ResultsSubjects with CAI had a greater activation in TA to forward (p < .01), forward affected (p = .001), backward affected (p = .007) and backward directions (p < .01); in PL to forward affected (p < .01) and affected directions (p = .001); in MG to forward (p = .023) and affected directions (p < .01) and in SOL to the affected direction (p = .009). We observed restricted excursions and less directional control in subjects with CAI.ConclusionsSubjects with CAI exhibited poorer ability to move their center of gravity within stability limits. In addition, they have an altered ankle muscle activity during LOS test toward the affected ankle joint.     

Lumbopelvic postural differences in adolescent idiopathic scoliosis: A pilot study

BackgroundA primary etiology of adolescent idiopathic scoliosis (AIS) is currently unknown, but poor postural control of the spinal extensor musculature has been identified as an AIS risk factor. Identifiable postural differences would aid in advancing the precise postural behaviors that should be modified during Physiotherapy Scoliosis Specific Exercise (PSSE) to help limit the progression of AIS.Research questionAre there any determinable differences in lumbopelvic posture or range of motion between subjects with AIS and controls?MethodsThis prospective cohort pilot study consisted of 53 subjects (27 AIS and 26 control) aged 11–17 years. Subjects had their lumbopelvic posture assessed and monitored using the ViMove DorsaVi sensor package. All subjects underwent a live assessment to obtain initial lumbopelvic (LP) range of motion (ROM) measurements. Subjects were then monitored while continuing with normal activities of daily living (ADLs) for 12 h. With an alpha level of 0.05, nonparametric analyses were performed for each variable via a Mann-Whitney U-test.ResultsDuring the live assessment, controls exhibited a significantly greater anterior pelvic tilt ROM in the sitting position than the AIS group (p = 0.0433). When compared to female controls, females with AIS had a sitting pelvic tilt ROM that was significantly more retroverted (p = 0.0232) and less anteverted (p = 0.0010). During ADLs, female controls exhibited a higher total number of extension events than their female with AIS (p = 0.0263). These associations did not strengthen with greater spinal deformity.SignificanceThis work demonstrates postural differences between patients with AIS and controls. Further study is necessary to determine why patients with AIS adopt these postures, and if PSSEs can be utilized to limit the progression of AIS.     

Knee strength outcomes in adolescents by age and sex during late-stage rehabilitation after anterior cruciate ligament reconstruction

ObjectiveTo determine if knee strength differences exist according to age group and sex among adolescents during late-stage anterior cruciate ligament reconstruction (ACLR) rehabilitation.DesignRetrospective cohort study.MethodsConsecutive patients who had undergone ACLR with a hamstring autograft completed isokinetic knee strength assessment. Patients were categorized into early (ages 11–14 years) and middle (ages 15–17 years) adolescence. A two-way MANOVA was used to examine strength differences according to age group and sex.Results144 patients were included in the analysis (56.9% females, age = 15.3 ± 1.5 years; days since surgery = 228.2 ± 41.2). Differences in quadriceps peak torque were identified between age groups on the involved (p = 0.001) and uninvolved limbs (p < 0.001), however, no differences in quadriceps peak torque were found between age groups when normalized to body mass (p = 0.16–0.49). Differences between groups according to sex were identified for each strength outcome (p < 0.01), with decreased normalized quadriceps (12–13%) and hamstring (13–16%) peak torque for females. No interactions between age group and sex were noted, F(8, 133) = 1.48, p = 0.17.ConclusionEarly adolescents produced less quadriceps and hamstring peak torque compared to middle adolescents after ACLR. No differences were found between age groups when normalized to body mass.     

Exploring correlations between the breast density of the women of Papua New Guinea and breast cancer risk factors

IntroductionPapua New Guinea (PNG), has experienced an increase in breast cancer incidence correlating to the westernisation of the country. Increased breast density is known to increase breast cancer risk. This study investigates if there are any factors unique to the women of PNG that may impact breast density and breast cancer risk.MethodA survey was undertaken of 1,161 women who had undergone mammographic imaging at the Pacific International Hospital (PIH). Results were correlated with the five Tabár mammographic parenchymal patterns (TP), recorded for each woman and geographical location, parity, breast size, occupation, marital and menstrual status, smoking and alcohol consumption, hormone replacement therapy (HRT), and exercise. Statistical analysis was undertaken using chi-square test, Fisher's exact test and Odds Ratio (OR).ResultsRelationships were identified between TP and parity (p < 0.001), marital status (p < 0.001), smoking (p < 0.001), alcohol intake (p = 0.029) and HRT (p = 0.029). There was no evidence of a relationship between pattern type and geographical location (p = 0.290), breast size (p = 0.592), occupation (p = 0.724), menstruation (p = 0.866) or exercise (p = 0.290). Married women, OR = 0.4004, CI 95% (0.2873–0.5579) and those with higher parity, OR 0.5034, CI 95% (0.3693–0.6862) were half as likely to have increased breast density reducing risk.ConclusionThere was no clear relationship across almost all data. Factors associated with increased breast density in PNG included parity, marital status, smoking, alcohol, and HRT use were evidenced in this snapshot of PNG women. Breast cancer risk was shown to be reduced for married women and those with increased parity.     

Evaluation of the uterine scar stiffness in women with previous Cesarean section by ultrasound elastography: A cohort study

PurposeTo evaluate by means of elastography if the quantitative assessment of the cesarean scar elasticity is feasible using as reference the surrounding intact myometrium and to investigate if the cesarean scar stiffness is influenced by the clinical characteristics of the previous cesarean delivery.MethodsProspective study including women with a previous Cesarean Section (CS) ≥ 37 weeks' gestation performed 12–15 months before. By transvaginal ultrasound two regions of interest (ROI) were selected: uterine scar (Region 1) and surrounding myometrium (Region 2). Strain index (SI) for each ROI was calculated and the Strain Ratio (SR) was defined as Region 1 SI/Region 2 SI. The primary outcome was to compare SR among women who were grouped in accordance to presence of previous vaginal delivery, CS during labor, type of suture or pyrexia during post-partum. The secondary outcome of this study was to evaluate the correlation between SR and maternal, neonatal and labor characteristics.Results68 women were included. The mean SR was 1.8 ± 0.7 thus indicating an increased stiffness of the uterine scar compared to the surrounding myometrium. No significant differences were found in terms of SR according to presence of previous VD, CS during labor, type of suture or pyrexia during post-partum period. Strain Ratio was not correlated to maternal characteristics nor to labor and neonatal outcome.ConclusionsEvaluation of uterine scar stiffness is feasible by using elastography. The stiffness of the uterine scar is higher than that of the surrounding myometrium and is not correlated to maternal and labor characteristics.     

Instrumented measures of postural control in college dancers with and without chronic ankle instability

ObjectivesTo determine whether collegiate dancers with chronic ankle instability (CAI) demonstrated impaired postural control during instrumented measures of single-leg static balance compared to dancers without CAI.DesignCross sectional design.SettingUniversity dance studios.ParticipantsWe included N = 39 dance majors from a large, public university. We stratified participants into CAI (n = 20, age = 20 ± 1.8, IdFAI = 17.3 ± 5.7, number of sprains = 1.9 ± 1.1) and Control groups (n = 19, age = 20 ± 1.2, IdFAI = 2.5 ± 3.0).Main outcome measuresParticipants performed 3 x 10-s single-leg, static balance trials on a pressure mat in two different conditions, foot-flat eyes closed and demi-pointe eyes open. We measured six different time-to-boundary (TTB) measurements during each balance trial and calculated the average of the 3 trials for each condition. Participants also completed the Foot and Ankle Ability Measure (FAAM) sport and activities of daily living (ADL) questionnaires.ResultsThe CAI group reported greater IdFAI and lower FAAM-ADL and FAAM-Sport scores compared to the control group. We observed no significant differences in TTB measurements between the CAI and control groups during either balance conditions.ConclusionsInstrumented measures of static postural control were not impaired in college dancers with CAI compared dancers without CAI.     

Running mechanics during 1600 meter track runs in young adults with and without chronic ankle instability

ObjectiveTo evaluate biomechanical measures in runners with and without chronic ankle instability (CAI) using wearable sensors during two 1600 m track runs at a slow- and fast-pace.DesignObservational case-control.SettingField.Participants18 recreational runners (CAI: n = 9; Healthy: n = 9) with rearfoot strike patterns.Main outcome measuresPronation excursion, maximum pronation velocity, peak braking g, peak impact g, contact time, cycle time, and stride length of every step of two 1600 m runs were collected using RunScribe™ sensors and binned to each 400 m lap (Lap 1 to Lap 4).ResultsSignificant group-by-lap interactions were identified for contact time (p = .05) during the slow-intensity run. The CAI group had greater contact time (p = 0.05) that progressively increased with distance completed. CAI group also had higher impact g than the control group throughout the slow-intensity run (p = .03). During the fast-intensity run, significant group by lap interaction was observed for pronation excursion with the CAI group exhibiting less pronation excursion than the healthy group as the run progressed (p = .002).ConclusionsRegardless of speed, runners with CAI demonstrated altered gait mechanics compared to healthy controls. During the higher intensity run, decreased pronation excursion was observed in the CAI group and differences became more prominent as the distance increased.