Effectiveness of Bilateral Transforaminal Epidural Steroid Injections in Degenerative Lumbar Spinal Stenosis Patients With Neurogenic Claudication: A Case Series

Background

As our population ages, neurogenic claudication (NC) from central canal stenosis of the lumbar spine is becoming an increasingly common condition. Studies have been undertaken to assess the efficacy of caudal, interlaminar, or unilateral transforaminal epidural injections, but bilateral transforaminal epidural injections (BTESIs) have not been evaluated to date.

Aquatic myofascial release applied after high intensity exercise increases flexibility and decreases pain

Objectives

To investigate aquatic myofascial release (AMR) effects on flexibility and delayed onset muscle soreness, after high intensity exercises. Study Design: 15 participants, control (CON) and intervention (INT), 3 moments, pre (Pre), after (Post) and 50 min after (Post 50/Post AMR). 6 exercises, 5 sets, 15 reps at 85% of 1 maximum repetition, followed, or not, by 50 min of AMR. Variables: Heart rate, lactate, rate of perceived exertion, pain and flexibility. Results: Pain perception decreased in all moments (CON4.47 ± 2.36; INT1.13 ± 1.46, p = 0.0002). Flexibility only increased for the fingertip to floor test in both phases in the Post50/Post AMR compared to Post (CON14.33 ± 9.19Pre, 15.07 ± 9.37Post (p = 0.7) and 12.8 ± 4.69Post50 (p = 0.4); INT14.53 ± 9.06Pre, 13.87 ± 9.88Post (p = 0.2) and 11.03 ± 8.96Post AMR (p = 0.001)). The Well's bench improved only for the Post AMR compared to Pre in the INT phase (INT24.79 ± 9.91Pre; 27.67 ± 9.46Post AMR p = 0.0000023). Conclusion: We concluded that AMR is effective to reduce pain perception and to improve flexibility of the studied population submitted to a high intense exercise session.     

Exercise Prescription Using a Group-Normalized Rating of Perceived Exertion in Adolescents and Adults With Spina Bifida

Background

People with spina bifida (SB) face personal and environmental barriers to exercise that contribute to physical inactivity, obesity, risk of cardiovascular disease, and poor aerobic fitness. The WHEEL rating of perceived exertion (RPE) Scale was validated in people with SB to monitor exercise intensity. However, the psycho-physiological link between RPE and ventilatory breakpoint (Vpt), the group-normalized perceptual response, has not been determined and would provide a starting point for aerobic exercise in this cohort.

Painful procedures and analgesia in hospitalized newborns: A prospective longitudinal study

Objective

To identify the type and frequency of stressful and painful procedures, the use of pharmacological and non-pharmacological strategies; to identify relationships between demographic and clinical variables with frequency of procedures and pain management.

Human growth hormone radioiodination using different batches of 125I of various ages

The reproducibility and the influence of the batch and decay level of Na125I on the radioiodination of human growth hormone (hGH) were examined by a polyacrylamide gel electrophoresis (PAGE) technique. The between-day coefficient of variation (CV) exhibited a value of 11.9% for labelling yields and 14.3% for antibody specific binding. The within-day variation for different shipments and isotope decay-levels was similar to that for the control experiment, carried out under the same conditions, using Na125I from a single lot. The results indicate that the decay-level and batch do not significantly influence either the yields or the immunological properties of the labelled product. The suitability of this PAGE technique as a control test for radioiodinated proteins is established by comparison with gel chromatography on Sephadex G-100.     

Understanding and interpreting confidence and credible intervals around effect estimates

IntroductionReporting confidence intervals in scientific articles is important and relevant for evidence-based practice. Clinicians should understand confidence intervals in order to determine if they can realistically expect results similar to those presented in research studies when they implement the scientific evidence in clinical practice. The aims of this masterclass are: (1) to discuss confidence intervals around effect estimates; (2) to understand confidence intervals estimation (frequentist and Bayesian approaches); and (3) to interpret such uncertainty measures.ContentConfidence intervals are measures of uncertainty around effect estimates. Interpretation of the frequentist 95% confidence interval: we can be 95% confident that the true (unknown) estimate would lie within the lower and upper limits of the interval, based on hypothesized repeats of the experiment. Many researchers and health professionals oversimplify the interpretation of the frequentist 95% confidence interval by dichotomizing it in statistically significant or non-statistically significant, hampering a proper discussion on the values, the width (precision) and the practical implications of such interval. Interpretation of the Bayesian 95% confidence interval (which is known as credible interval): there is a 95% probability that the true (unknown) estimate would lie within the interval, given the evidence provided by the observed data.ConclusionsThe use and reporting of confidence intervals should be encouraged in all scientific articles. Clinicians should consider using the interpretation, relevance and applicability of confidence intervals in real-world decision-making. Training and education may enhance knowledge and skills related to estimating, understanding and interpreting uncertainty measures, reducing the barriers for their use under either frequentist or Bayesian approaches.     

Reliability in Mandibular Movement Evaluation Using Photogrammetry in Patients With Temporomandibular Disorders

ObjectiveThe purpose of this study was to propose a quantitative evaluation for mandibular opening–closing movement asymmetries and to verify the intraexaminer and interexaminer reliability using photogrammetry in individuals with and without myogenic temporomandibular disorders.MethodsForty-nine female participants between ages 18 and 40 were enrolled in this study. They were assigned to 2 different groups: a temporomandibular disorder group, (n = 25; 28.1 ± 3.6 years) and an asymptomatic group (n = 24; 25.6 ± 5.1 years). Data were collected through photogrammetry using Corel Draw X3 software (Corel Corp, Ottawa, Ontario, Canada) for angle measurements. Reliability analysis was done on the total sample, and the photographs were obtained by a singular examiner on 2 occasions (intraexaminer) 1 month apart and from measurement made by another examiner (interexaminer) on different days. The intraclass correlation coefficient (ICC) was applied with a significance level of 5%.ResultsThe photogrammetry had excellent intrarater and inter-rater reliability for the evaluation of opening and closing movements of the jaw (intrarater: opening ICC = 0.99; closing ICC = 0.98; inter-rater: opening ICC = 0.89 and closing ICC = 0.82). Photogrammetry also demonstrated excellent intra- and inter-rater reliability in the evaluation of head posture (intra-rater: head deviation ICC = 0.96; head position ICC = 0.75; inter-rater: head deviation ICC = 0.98; head position ICC = 0.98).ConclusionUnder these experimental conditions, most angular values presented excellent intra- and interexaminer reliability.