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Introduction:The strength of inspiratory muscles is one of the essential factors in preventing postoperative pulmonary complications (POPC). One of the new tools to safely measure the strength of the inspiratory muscles in heart patients dynamically and without breath holding is the strength-index (S-index). This study aims to evaluate the immediate effects of a respiratory warm-up (RWU) session on the S-index and other lung parameters in cardiac surgery candidates, a subject with limited existing research. Materials and Methods: This study was conducted as a randomized controlled trial. Forty participants scheduled for heart surgeries were randomly assigned to either the study (RWU between two tests) or control (without RWU) groups. RWU consists of threshold loading inspiratory muscle training (TL-IMT) exercises at 30% of the S-index with 30 breathing cycles. Respiratory tests, including S-index, peak inspiratory flow (PIF) and vital capacity (VC), were assessed twice using an electronic respiratory device. Results: Covariance analysis showed no significant difference in the average and best values of the S-index, PIF or VC indices at the second tests, between two groups (P>0.05), or in the independent t test and Mann-Whitney U test for the "rate of changes," between two tests (P>0.05). Finally, intragroup changes, assessed with paired sample t test between two tests, were mostly non-significant for these indices (P>0.05), except for the best VC in the study group (P=0.03). Conclusion: The study results suggest that a RWU session does not significantly impact cardiac surgery candidates' S-index or other respiratory parameters. Thus, incorporating RWU before S-index testing may not be necessary. [ABSTRACT FROM AUTHOR]

Introduction: Low back pain is a leading cause of disability worldwide. Various treatments have been recommended to address this prevalent issue, with core stability and McKenzie exercises being among the most evidence-based options. However, recent comparative studies lack mechanical assessment and functional tests. This study compares the effects of core stability and McKenzie exercises on the range of motion, pain, disability, and function in patients with mechanical low back pain. Materials and Methods: In this clinical trial, 22 patients received core stability exercises, and 22 received McKenzie exercises based on individual mechanical assessments. Before treatment, each patient underwent mechanical assessment via the McKenzie mechanical assessment form, pain assessment using the visual analog scale, disability evaluation with the Oswestry disability index questionnaire, muscle control, as well as function assessment with unilateral single limb stance, and range of motion evaluation using fingertip-to-floor distance measurements. All variables were measured again after 8 sessions over two weeks of intervention. Results: Both groups showed significant improvements in trunk flexion range of motion, disability, functional status, and pain (P>0.05). However, the two groups had no significant differences (P<0.05). Conclusion: Both core stabilization and McKenzie exercises are effective in reducing pain disability, increasing range of motion, and enhancing functional status in patients with mechanical low back pain. [ABSTRACT FROM AUTHOR]

Introduction: Autism spectrum disorder (ASD) is a sensory processing, social communication, and occupational performance disorder. Sensory diets can have positive effects on these fields. Current research compared the effectiveness of the sensory diet program with and without teleoccupational therapy on sensory processing patterns, social competency and occupational performance in children with ASD. Materials and Methods: The study sample comprised 32 children with ASD 4-10 years old. They were placed in the control and intervention groups. The number of sessions for both groups was 20 30-minute sessions administered over 8 weeks. Through photos, videos, and explanations, sensory problems were described in both groups, the mother presented and implemented activities and environmental adaptations, and the therapist supervised the implementation. This study used three tools--sensory profile 2, social responsive scale 2 and Canadian occupational performance measure. Results: According to the sensory profile 2, social responsiveness scale, and Canadian occupational performance measure, processing in the areas of auditory, visual, touch, movement, body position, oral, conduct, social-emotional, attentional, sensory seeking, sensory avoiding, sensory sensitive, low registration, social awareness, social cognition, social communication, social motivation, limited interests, repetitive behaviors, and occupational performance in both groups have a significant difference (P<0.05). Conclusion: It seems that providing a sensory diet program through teleoccupational therapy on sensory processing patterns, social competency, and occupational performance is applicable, as well as face-to-face occupational therapy in children with ASD. [ABSTRACT FROM AUTHOR]

ObjectiveThe purpose of this study was to investigate the intra-rater reliability and validity of a designed load cell setup for the measurement of back extensor muscle force and endurance.ParticipantsThe study sample included 19 older women with hyperkyphosis, mean age 67.0 ± 5.0 years, and 14 older women without hyperkyphosis, mean age 63.0 ± 6.0 years.MethodsMaximum back extensor force and endurance were measured in a sitting position with a designed load cell setup. Tests were performed by the same examiner on two separate days within a 72-hour interval. The intra-rater reliability of the measurements was analyzed using intraclass correlation coefficient (ICC), standard errors of measurement (SEM), and minimal detectable change (MDC). The validity of the setup was determined using Pearson correlation analysis and independent t-test.ResultsUsing our designed load cell, the values of ICC indicated very high reliability of force measurement (hyperkyphosis group: 0.96, normal group: 0.97) and high reliability of endurance measurement (hyperkyphosis group: 0.82, normal group: 0.89). For all tests, the values of SEM and MDC were low in both groups. A significant correlation between two documented forces (load cell force and target force) and significant differences in the muscle force and endurance among the two groups were found.ConclusionThe measurements of static back muscle force and endurance are reliable and valid with our designed setup in older women with and without hyperkyphosis.

OBJECTIVE:The purpose of this study was to investigate the intrarater reliability of a skin-surface instrument (Spinal Mouse, Idiag, Voletswil, Switzerland) in measuring standing sagittal curvature and global mobility of the spine in older women with and without hyperkyphosis. METHODS:Measurements were made in 19 women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 67 ± 5 years, and 14 women without hyperkyphosis (thoracic kyphosis angle

Background and Aim: Real-Ear-to-Coupler Difference (RECD) is affected by the type of transducer and its coupling method. This study aimed to investigate the effect of receiver type used in Receiver-in-Canal (RIC) hearing aids on RECD and Coupler Response for Flat Insertion Gain (CORFIG) obtained by the same coupling method. Methods: In this study, the right ears of 30 normal-hearing adults (25 men and 5 women, with a mean age of 28.13±5.62 years) were studied. We used the RIC hearing aids with two standard and power receivers. The foam of the ER-3A insert earphone was used as a coupling system in both receivers. By using the Audiogram Direct test within Phonak's fitting software, 70 dB HL intensity was produced at different frequencies, once in the realear and again in the HA-1 coupler. By assessing the difference between real-ear and HA-1 coupler measurements, the RECD was first obtained. Then, the CORFIG was obtained at different frequencies by subtracting the Microphone Location Effect (MLE) and RECD from Real-Ear Unaided Gain (REUG). Results: The RECD and CORFIG values obtained from the standard receiver at all frequencies were significantly different from those from the power receiver (p<0.05), where the use of the power receiver resulted in lower RECD and higher CORFIG. With the increase in frequency, the RECD increased. A small frequency changes of 50 Hz had a significant effect on RECD and CORFIG. Conclusion: The type of receiver used in RIC hearing aids has a significant effect on the RECD and CORFIG values. [ABSTRACT FROM AUTHOR]

Introduction: Endodontic therapy has been regarded as a safe treatment option with highly promising results in preserving natural teeth. Numerous factors may influence the longevity of endodontically treated teeth (ETT), thus altering their success/survival rate. This study aimed to determine the survival and success rates of endodontically treated premolars and molars with different complex restorative/prosthodontic treatments. Materials and Methods: A total of 190 patients with an ETT were included, who had received final coronal restoration up to 14 days after the temporary one and at least one year prior to the enrollment. The investigator evaluated the quality of endodontic filling, coronal restoration, mobility, and proximal contacts. Data were analyzed with multiple binary logistic regression and the Chi-Square test. Results: The average duration of followup was 28.6±11.9 months. Overall, 89.4% (170/190) of the teeth survived. The overall success rate for the investigated teeth was 70.5% (134/190). Success rates of 100% for crown, 95.7% for post and core crown (PCC), and 94.7% for amalgam build-up with post were achieved. However, the success rates were 75%, 52.5%, and 50% for amalgam build-up, composite build-up, and PCC with crown lengthening, respectively. The Chi-square test revealed that there was a significant difference between the different restorations in terms of success (P<0.001). Multiple binary logistic regression models revealed that coronal leakage (P=0.048), obturation void (P=0.037), obturation length (P=0.020), mobility (P=0.002), type of the restoration (P<0.001), and proximal contact (P<0.001) were significant predictors for success. However, apical lucency, root length, marginal caries, tooth type, and post did not appear to be significant indicators of success (P>0.05). Conclusions: ETT with minimal mobility, exhibiting underfilled obturations without visible voids, and having received crown/PCC/amalgam build-up with a post, along with the presence of both proximal contacts, tend to exhibit a significantly high success rate. [ABSTRACT FROM AUTHOR]

Objective Electromyography (EMG) biofeedback has been suggested as a relatively new approach to help resolve muscle disorders. This research aimed to evaluate the influence of 8 weeks of proximal pelvic muscle training and biofeedback on pain, muscle strength, and their EMG activity in individuals suffering from patellofemoral pain syndrome (PFPS). Materials & Methods This randomized clinical trial was performed on 30 young people aged 22 to 45 with PFPS. People in the intervention group (15 people) received EMG biofeedback of the abductor (gluteus medius) and external rotator (gluteus maximus) muscles along with routine physiotherapy treatments, including stretching exercises, isometric exercises of gluteal and quadriceps muscles, and conventional transcutaneous electrical nerve stimulation. In the control group (15 people), routine physiotherapy treatments were only performed on the patients. The participants of two groups were treated for 8 weeks, 3 sessions every week. Pain by a visual analog scale (VAS), maximal voluntary isometric strength (MVIC) of the abductor and external rotator muscles of the thigh with a dynamometer, and activity of these muscles, including maximum contraction, integrated EMG and onset EMG using EMG, were measured before and after the interventions. Results MVIC and EMG of the gluteus medius muscle demonstrated that the intervention group had more maximum EMG activity (P=0.043) and MVIC (P=0.003) than the control group. MVIC and the maximum EMG activity of the gluteus maximus muscle showed no significant difference between the two groups. Still, the increase in the integrated EMG of this muscle in the intervention group indicated a greater increase than in the control group (P=0.0001). Moreover, people in the intervention group had significantly less pain than the group of routine exercises alone after 8 weeks of treatment (P=0.016). Conclusion Adding 8 week biofeedback training of abductor and external rotator muscles to the routine therapeutic exercise in PFPS can lead to pain reduction, improvement of muscle strength and better performance of these muscles. This change could potentially slow down the degenerative process of the patellofemoral joint. [ABSTRACT FROM AUTHOR]

Objective This study aimed to investigate the relationship between psychological factors and clinical outcomes of therapeutic exercise after 3 months in individuals undergoing total knee arthroplasty (TKA). Another aim of this study was to evaluate the effect of 3 months of therapeutic exercise on the psychological factors of these patients. Materials & Methods This quasi-experimental study involved 29 patients with an average age of 62.76 years who had undergone TKA for their first knees. These patients performed therapeutic exercises for three months. Pain intensity and range of motion (ROM) of flexion and extension were assessed 3 times: before surgery, at the beginning of physiotherapy and 12 weeks after therapeutic exercises. Patients' functional ability and psychological indicators were evaluated in two phases: Before surgery and at the end of the 12th week. Clinical outcomes, including pain, knee ROM, and functional ability, were assessed using the visual analog scale, goniometer and Oxford knee score, respectively. The depression index was assessed with the Beck depression inventory (BDI) second version, anxiety with the state-trait anxiety index, fear of movement with the tampa scale of kinesiophobia (TSK) questionnaire and pain catastrophizing with the pain catastrophizing scale questionnaire. Results The results showed that two psychological indices, including trait anxiety and pain catastrophizing, had a significant negative correlation with the clinical outcomes of physiotherapy after TKA. The higher the trait anxiety before surgery was, the lower the pain reduction during the activity (r=-0.574, P=0.002) and the lower the improvement in functional abilities (r=-0.402, P=0.038). Also, the higher the index of preoperative pain catastrophizing, the lower the pain reduction during activity (r=-470, P=0.013) and the lower the improvement in functional abilities (r=-0.436, P=0.023). No significant correlation was found between other psychological indicators before surgery and the clinical outcomes of physiotherapy. On the other hand, among the psychological factors, trait anxiety (P=0.01) and fear of movement (P=0.01) were significantly improved after 3-month therapeutic exercise. Conclusion Psychological factors can play an essential role in predicting the clinical outcomes of physiotherapy after TKA. In addition, the improvement of psychological factors after therapeutic exercises may indicate that these psychological problems can be improved by reducing pain and achieving better ROM during treatment, so psychological factors are not considered an obstacle to surgery. [ABSTRACT FROM AUTHOR]

To evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine via primary intraosseous (IO) injection with the QuickSleeper device vs inferior alveolar nerve block (IANB) for mandibular first molars diagnosed with symptomatic irreversible pulpitis (SIP). Sixty-four patients with a first mandibular molar with SIP were randomly divided into 2 groups: IO (n = 32) and IANB (n = 32). Each received either an IO injection with the 5th generation QuickSleeper device or a conventional IANB with 1.7 mL 4% articaine with 1:100,000 epinephrine. Success was defined as no/mild pain upon the access cavity preparation and initial filing. Injection pain, anesthetic onset, heart rate (HR) change, HR recovery time, and duration of anesthesia were also recorded and analyzed. The success rates were 40.6% for IANB and 81.2% for IO (P <.001). IO exhibited a significantly lower injection pain (P =.027), a shorter onset of action (P <.001), a greater heart rate increase (P <.001), a faster heart rate recovery time (P <.001), and a shorter duration of action (P <.001) vs IANB. Primary IO anesthesia using the fifth generation of the QuickSleeper device was more successful than IANB when using 4% articaine with 1:100,000 epinephrine to anesthetize mandibular first molars with SIP. The QuickSleeper device appeared to be a viable alternative to IANB for mandibular anesthesia. [ABSTRACT FROM AUTHOR]

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Introduction: The amount of thoracic kyphosis and its mobility may be affected by gender in older adults. This study investigates gender differences in thoracic kyphosis and thoracic spine mobility in healthy older adults. Materials and Methods: In this cross-sectional study, 36 participants among which 21 were female and 15 were male with an age range of 65-80 years participated. The amount of thoracic spine kyphosis was measured in a relaxed standing position and the position of maximum correction of thoracic kyphosis using a flexible ruler between the spinous processes of T12 and C7. The difference between the thoracic kyphosis of the relaxed state and the condition of the maximum correction is used to determine the degree of thoracic spine mobility. Finally, men and women were compared in terms of thoracic kyphosis and thoracic spine mobility. The student t-test was employed to compare kyphosis and spinal mobility between men and women, and the paired student t-test was used to compare kyphosis angle in a relaxed posture and maximum kyphosis correction status. Meanwhile, the Pearson test was utilized to evaluate the relationship between variables. Results: Although there was no statistically significant difference in the mean thoracic kyphosis of relaxation (P=0.13) and maximal correction (P=0.18) status of healthy old men and women, there was a significant positive relationship between the rate of kyphosis angle and the amount of mobility of thoracic kyphosis (P=0.003; r=0.48). Conclusion: There is no difference in the degree of kyphosis and thoracic spine mobility in older men and women. In addition, people with more thoracic kyphosis had more spinal mobility. [ABSTRACT FROM AUTHOR]

Background and Aim: The Acceptable Noise Level (ANL), which is an effective clinical tool for quantitative assessment of noise tolerance, is affected by some known variables related to both subject and testing materials. The present study examined how the characteristics of different babble noises may affect the ANL results in normal adult listeners. Methods: Forty Persian listeners with normal hearing participated. In addition to typical ANL testing with 12-talker noise, the ANL was obtained in 8 different conditions varying in number of talkers from 2 to 10 in the babble noises presenting forward and backward. Results: There was a significantly lower ANL for 2-talker babble compared to 4, 8, 10, and 12-talker babble in both forward and backward noise conditions. With the increase in talkers in noise, the ANL becomes worse but reaches almost a plateau with more than 4 talkers in babble noise. There was a statistically significant difference between 2-talker forward and 2-talker backward noises, with no difference for the other conditions. Conclusion: This finding that the ANL is affected by the number of talkers in babble noise and by the forward and backward background noise suggests that informational masking and listening in dip mechanisms are involved in ANL for normal hearing people at least. [ABSTRACT FROM AUTHOR]

Background: Pregnant women have poor knowledge of oral hygiene during pregnancy. One problem with the follow-up of dental caries in this group is zero accumulation in the decayed, missing, and filled teeth (DMFT) index, for which some models must be used to achieve valid results. The studied population may be heterogeneous in longitudinal studies, leading to biased estimates. We aimed to assess the impact of oral health education on dental caries in pregnant women using a suitable model in a longitudinal experimental study with heterogeneous random effects. Materials and Methods: This longitudinal, experimental research was carried out on pregnant women who visited medical centers in Tehran. The educational group (236 cases) received education for three sessions. The control group (200 cases) received only standard training. The DMFT index assessed oral and dental health at baseline, 6 months, and 24 months after delivery. The Chi-square test was used for comparing nominal variables and the Mann–Whitney U test for ordinal variables. The zero-inflated Poisson (ZIP) model was applied under heterogeneous and homogeneous random effects using R 4.2.1, SPSS 26, and SAS 9.4. The level of significance was set at 0.05. Results: Data from 436 women aged 15 years and older were analyzed. Zero accumulation in the DMFT was mainly related to the filled teeth (51%). The heterogeneous ZIP model fitted better to the data. On average, the intervention group exhibited a higher rate of change in filled teeth over time than the control group (P = 0.021). Conclusion: The proposed ZIP model is a suitable model for predicting filled teeth in pregnant women. An educational intervention during pregnancy can improve oral health in the long-term follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is one of the most debilitating diseases among adults worldwide and leads to persistent rehabilitation needs even at the chronic stage. Achieving good postural control is a critical requirement for daily activities which enhances quality of life (QoL) in patients with stroke. There is increasing evidence that transcranial direct current stimulation (tDCS) can be considered a promising adjunct technique to improve motor recovery after stroke. Evidence of augmented neuroplasticity after tDCS suggests that paired rehabilitation followed by consecutive use of tDCS may optimize recovery outcomes. Although a few randomized controlled trials have been conducted on upper limb rehabilitation in chronic stroke using tDCS, no study focused on balance training in chronic stroke patients. The present randomized, sham-controlled, double-blinded clinical study addresses brain stimulation targeting postural control using tDCS in chronic stroke. Methods: The study participants included chronic ischemic stroke individuals with postural control impairments who passed the exclusion criteria. Active or sham anodal tDCS was delivered to the lesioned leg motor cortex combined with balance training. The experimental group received active anodal tDCS stimulation (2 mA) for 20 min, daily for 5 days paired with balance training. Linear and nonlinear approaches were used to analyze postural sway changes pre-and post-intervention. Postural sway fluctuation, functional balance assessment using the Berg balance scale, and timed up-and-go test were conducted to compare the active and sham groups. Conclusion: This trial could have significant implications for balance rehabilitation after stroke in the ambulatory setting. If effective, this novel approach may improve rehabilitation protocol in this population. [ABSTRACT FROM AUTHOR]

Background and Aim: Experiencing dizziness/vertigo is often an indication of dysfunction in the vestibular system. Recent findings show a connection between peripheral vestibular dysfunction and cognitive impairments. The Neuropsychological Vertigo Inventory (NVI) can assess physical, emotional, and cognitive issues in individuals with dizziness/vertigo. The aim of this research was to translate, cultural adaptation and evaluation of the reliability and validity of NVI to Persian. Methods: In this descriptive-analytical study, the NVI scale was translated and adapted to the Iranian cultural context following the international quality of life assessment protocol for translation and equivalence. After obtaining face validity, the scale was administered to 140 patients with peripheral vestibular system dysfunction and 70 control group (age between 25 and 80 years). After one week, 50 participants were asked to complete the questionnaire again. Eventually, reliability was evaluated with both methods of internal consistency and test-retest reproducibility. Results: Out of the 28 items in the NVI scale, 3 items were modified to better align with the cultural conditions of Iranians. The impact scores for most items in this scale were found to be higher than 1.5. The Cronbach's alpha coefficient values for the overall scale (0.90) and test-retest reliability with intra-class correlation coefficient for the overall scale (0.91) were confirmed. Conclusion: The Persian version of NVI scale demonstrates excellent validity and reliability, and it exhibits a high level of content alignment with the original version. Therefore, it can be a useful tool to better understand the physical, emotional and cognitive disturbances in patients with vertigo/dizziness. [ABSTRACT FROM AUTHOR]

Background: To our knowledge, there is scant research on the use of rehabilitative ultrasound imaging (RUSI) method for evaluating bladder base displacement in pregnant women. The RUSI is a non-invasive and simple method that assesses the function of pelvic floor muscles (PFM) based on the movement of the bladder base. Objectives: This study aims to assess the reliability of the RUSI for the assessment of PFM function in pregnant women during voluntary muscle contractions. Materials & Methods: In this cross-sectional study, 18 pregnant women with different gestational ages participated. The amount of bladder base displacement during PFM contraction was assessed in all women and considered an indicator of PFM function. The test re-test reliability was evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman plot. The percentages of standard error of measurement (SEM%) and minimal detectable change (MDC%) were also calculated. Results: The mean amount of bladder base displacement during PFM contraction at time points 1 and 2 was 4.89±1.43 and 4.81±1.41, respectively. The ICC was 0.989 (95% CI, 0.969%, 0.996%), which indicates excellent reliability. The Bland-Altman plot showed that all the points were within the 95% limits of agreement with no considerable trend or bias. The SEM% and MDC% were 3.09% and 8.41%, respectively. Conclusion: The intra-rater reliability of the RUSI to assess PFM function in pregnant women is high, and can be useful for further studies on the PFMs in pregnant women. [ABSTRACT FROM AUTHOR]

Background: Pregnant women have poor knowledge of oral hygiene during pregnancy. One problem with the follow-up of dental caries in this group is zero accumulation in the decayed, missing, and filled teeth (DMFT) index, for which some models must be used to achieve valid results. The studied population may be heterogeneous in longitudinal studies, leading to biased estimates. We aimed to assess the impact of oral health education on dental caries in pregnant women using a suitable model in a longitudinal experimental study with heterogeneous random effects. Materials and Methods: This longitudinal, experimental research was carried out on pregnant women who visited medical centers in Tehran. The educational group (236 cases) received education for three sessions. The control group (200 cases) received only standard training. The DMFT index assessed oral and dental health at baseline, 6 months, and 24 months after delivery. The Chi-square test was used for comparing nominal variables and the Mann-Whitney U test for ordinal variables. The zero-inflated Poisson (ZIP) model was applied under heterogeneous and homogeneous random effects using R 4.2.1, SPSS 26, and SAS 9.4. The level of significance was set at 0.05. Results: Data from 436 women aged 15 years and older were analyzed. Zero accumulation in the DMFT was mainly related to the filled teeth (51%). The heterogeneous ZIP model fitted better to the data. On average, the intervention group exhibited a higher rate of change in filled teeth over time than the control group (P = 0.021). Conclusion: The proposed ZIP model is a suitable model for predicting filled teeth in pregnant women. An educational intervention during pregnancy can improve oral health in the long-term follow-up. [ABSTRACT FROM AUTHOR]

Aim: Calcium-enriched mixture (CEM) cement is an endodontic biomaterial; however, enhancing its physical/mechanical properties remains a challenge. This in vitro study investigates the influence of zirconium oxide (ZrO2) and zinc oxide (ZnO) nanoparticles on the setting time, microhardness, and compressive strength of CEM cement. Methods: Four different groups of CEM cement were prepared: a control group without nanoparticles, two groups with ZrO2 or ZnO, and a group with a combination of nanoparticles. The nanoparticles were added to the powder in predetermined concentrations. The setting time was evaluated using the Gilmore needle method, while microhardness and compressive strength were determined using Vickers hardness and a universal testing machine, respectively. Results: The incorporation of ZnO slightly reduced the setting time, while the addition of ZrO2 significantly prolonged it compared to the control group. Interestingly, the combination of both nanoparticles exhibited a setting time comparable to that of the control group. Regarding the microhardness and compressive strength, both ZrO2 and ZnO significantly improved these properties compared to the control group. The combination of both nanoparticles showed the highest microhardness and compressive strength values among all groups. Conclusions: The addition of nanoparticles to CEM cement effectively modifies its physical and mechanical properties. The optimal combination of these nanoparticles can potentially achieve an improved balance between setting time and enhanced mechanical performance. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the efficacy of the orifice-level passive ultrasonic activation (OL-PUA) technique in removing debris from the mesial root canals of mandibular molars, besides comparing it with other approaches, including manual dynamic agitation (MDA), EndoActivator, and laser-activated irrigation (LAI). Methods: Ninety mesial roots of mandibular molars were prepared up to 25.06 using the Race rotary system, filled with 3% sodium hypochlorite (NaOCl), and then they were randomly assigned to 5 groups (n = 15) based on the activation protocol: MDA, EndoActivator, OL-PUA, LAI (using a diode laser), and needle irrigation (no activation). Moreover, one group served as the negative control using normal saline as the final irrigant. The roots were decalcified and sectioned into coronal, middle, and apical cross-sections. After histological staining, the remaining debris was assessed with an optical microscope and measured in the canals and isthmuses using histomorphometric analysis. Statistical analyses were performed by using oneway ANOVA and Tukey's HSD post hoc test (P = 0.05). Results: Although less residual debris was observed after OL-PUA/LAI than using the EndoActivator/MDA methods, no significant difference was found between the four activation techniques at any root third (P > 0.05). The OL-PUA/LAI group harbored significantly less remaining debris than the needle-irrigated samples at all root thirds (P < 0.05). Debris accumulation increased from the coronal to the apical root thirds. Conclusion: No statistical difference was detected between the four activation techniques in terms of debris-removal performance, and none of them resulted in completely debris-free canals. Orifice-level PUA proved to be a promising approach with significant efficacy in removing debris compared to control groups. [ABSTRACT FROM AUTHOR]

Background and Aim: Questionnaires are useful tools for clinicians. This study aimed to translate the Dizziness Handicap Inventory for Patient Caregivers (DHI-PC) into Persian (DHI-PC-P) and assess its psychometric properties for children aged 5-12 years. Methods: This is a descriptive-analytical psychometrics study. After obtaining permission from the developers of the DHI-PC, translation into Persian and cross-cultural adaptation were done according to the international guidelines for self-assessment tools recommended by the American Association of Orthopedic Surgeons. Participants were 21 parents (mean age: 38.05 years, SD=6.1 years, 18 female) and their children with dizziness (mean age 8.69 years, SD=2.41 years, 9 female) between the ages of 5-12 years old. Face validity, content validity, and test-retest reliability at an interval of 14-21 days were evaluated for the DHI-PC-P. Results: The face validity was confirmed qualitatively by the experts' opinions and quantitatively by calculating the item impact score. Content validity was confirmed by calculating the content validity index and the content validity ratio (0.97 and 0.86, respectively). The internal consistency was good (Cronbach's alpha=0.90). For the testretest reliability, the intraclass correlation coefficient was obtained 0.94, indicating an excellent reliability. Conclusion: The DHI-PC-P can be used clinically as a valid and reliable tool for children with dizziness aged 5-12 years. [ABSTRACT FROM AUTHOR]

Objective Patients with knee osteoarthritis (KO) commonly show quadriceps muscle weakness. One of the important reasons for this weakness is arthrogenic muscle inhibition (AMI), a process in which neural inhibition causes the failure of quadriceps activation. The present study aims to evaluate the effect of cross-education on the AMI and the maximum extensor force of quadriceps in women with unilateral KO. Materials & Methods In this study, 21 women with unilateral KO (grade 2) participated. The AMI and the maximum extensor force of the quadriceps in the affected knee were measured before, immediately after, and 15 minutes after cross-education. The cross-education included isometric training of the contralateral quadriceps in 5 sets of 8 repetitions in one session. For measuring the AMI and maximum extensor force of the quadriceps, a burst of electrical stimulation was superimposed on the maximal voluntary contractions in 6 seconds. Results Immediately after one session of cross-education, the AMI of the affected knee significantly decreased and the maximum extensor force of quadriceps significantly increased compared to the pretest phase (P=0.001). Fifteen minutes after cross-education, AMI significantly increased compared to the post-test phase (P=0.018), but was still lower than that in the pre-test phase (P=0.001) Conclusion One session of cross-education can reduce AMI and increase maximum extensor force of quadriceps in women with KO, and this effect remains for at least 15 minutes. [ABSTRACT FROM AUTHOR]

Background and Aims Diabetes mellitus is one of the most prevalent metabolic conditions in the world. One of its consequences is overactive bladder (OAB), which is a syndrome whose symptoms appear during the urine storage phase in the form of increased urinary frequency or urinary urgency. The prevalence of this disorder is estimated to be 22.5-24.2 % in people with type 2 diabetes (T2D). Recently, a useful technique for the treatment of OAB, named transcutaneous tibial nerve stimulation (TTNS), has been introduced. This study aims to investigate the effect of TTNS in women with T2D and OAB. Methods This randomized, double-blind clinical trial was conducted on 40 women with T2D and OAB symptoms, who were divided into two control and intervention groups. The control group performed pelvic floor muscle (PFM) training daily for one month, while the intervention group received 12 sessions of TTNS combined with PFM training. Before and after the intervention, the lower urinary tract symptoms were recorded using the Persian version of the International Consultation on Incontinence Modular Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Independent t-test, paired t-test, Wilcoxon test, Mann-Whitney U test, and chi-square test were performed for data analysis using SPSS software, version 24. Results There was no significant difference between the two groups in the ICIQ-FLUTS score, incontinence quality of life, or PFM strength, and endurance (P>0.05). However, their scores were significantly different after treatment in each group compared to the pre-treatment phase (P≤0.05). Conclusion The combination of TTNS and PFM training has no advantage over PFM training alone in managing OAB symptoms and improving PFM strength and quality of life in women with T2D. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the effect of flexi-bar and stabilization exercises on static and dynamic postural control in patients with chronic nonspecific low back pain. Patients and methods: In this randomized controlled study conducted between November 2019 and March 2020, 38 patients (19 males, 19 females; mean age: 33.8±6.2 years; range, 20 to 45 years) were randomly assigned into flexi-bar (n=19) and stabilization (n=19) groups. Both groups received general physiotherapy for three sessions per week, a total of 10 sessions. Besides, the flexi-bar group received flexi-bar exercises, and the stabilization group received stabilization exercises. Postural sway was assessed with a force platform in three difficult conditions, including open eye, close eye, and one-leg standing and dynamic posture with the modified Star Excursion Balance Test. Results: After the intervention, both groups showed a significant improvement in static and dynamic postural control (p<0.05). However, no significant differences were found between groups after treatment, while only the phase-plane portrait of opened eyes condition was significantly improved (p=0.03), in the flexi-bar group compared to the stabilization group. Conclusion: Both flexi-bar and stabilization exercises effectively improved static and dynamic postural control, but none of the exercises was superior to the other. Flexi-bar is recommended as an effective tool in low back pain rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to compare the accuracy and agreement between cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT) in the assessment of canal transportation and centering ratio following root canal instrumentation with rotary files. Material and Methods: Twenty mesiobuccal canals of mandibular molars were prepared using the 2Shape sequential rotary system. CBCT and micro-CT scans were performed before and after instrumentation, and the magnitude of transportation and centering ratio were measured. The acceptable transportation was set at ≤0.15 mm. The accuracy and agreement between CBCT and micro-CT were calculated, and the intra-class correlation coefficient (ICC) and kappa coefficient were determined to assess the agreement between the two modalities. Statistical analyses were performed using repeated measures ANOVA. Results: Transportation was detected by both modalities at all distances from the apex after instrumentation. The agreement between CBCT and micro-CT in assessing canal transportation was observed in 80%, 85%, 75%, and 75% of specimens at 1-, 3-, 5-, and 7-mm from the apex, respectively. The ICC for transportation and centering ratio was much lower than 0.75, indicating poor agreement between the modalities. The kappa coefficient did not show acceptable agreement between the methods. Conclusions: CBCT and micro-CT demonstrated poor agreement in assessing canal transportation and centering ratio. Micro-CT remains the preferred modality for in vitro investigations, while CBCT should be limited to clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: Some accurate tools exist to assess fear-avoidance behavior, such as the Tampa scale for kinesiophobia (TSK) in individuals with musculoskeletal problems. The current research aims to compare the psychometric characteristics of the original 17-items TSK questionnaire and its 11-item brief version in chronic non-specific low-back pain (CNSLBP). Materials and Methods: In this test development study, 295 patients with CNSLBP referred to the physiotherapy clinic of Milad Hospital in Tehran city, Iran were evaluated. Confirmatory factor analysis (CFA) and α Cronbach was conducted to assess the validity and reliability of the original and brief version of the TSK, respectively. For goodness-of-fit, the Χ²/df, root mean square error of approximation (RMSEA), goodness-of-fit index (GFI), and comparative fit index (CFI) indices were used. Results: Internal consistency specified by Cronbach's α was 0.949 for the original version of the questionnaire and 0.927 for the brief one. Based on the CFA findings, the goodness-of-fit indices for the brief version were GFI=0.921, RMSEA=0.078 (90% confidence interval (CI), 0.062%-0.094%), comparative fit index (CFI)=0.981, and Χ²/df=2.791. These indices for the original one were 0.882, 0.066 (90% CI, 0.055%-0.076%), 0.983, and 2.270, respectively. A significant correlation was found between these two versions (P<0.001). These findings confirm the adequacy of the brief version of the TSK. Conclusion: The brief version of TSK can be considered a reliable and valid tool to evaluate somatic focus and activity avoidance in patients with CNSLBP. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the frequency of facial asymmetry parameters in patients with head tilt versus those with head turn. Methods: This cross-sectional comparative study was performed on 155 cases, including 58 patients with congenital pure head turn due to Duane retraction syndrome (DRS), 33 patients with congenital pure head tilt due to upshoot in adduction or DRS, and 64 orthotropic subjects as the control group. The facial appearance was evaluated by computerized analysis of digital photographs of patients' faces. Relative facial size (the ratio of the distance between the external canthus and the corner of the lips of both face sides) and facial angle (the angular difference between a line that connects two external canthi and another line that connects the two corners of the lips) measured as quantitative facial parameters. Qualitative parameters were evaluated by the presence of one-sided face, cheek, and nostril compression; and columella deviation. Results: The facial asymmetry frequency in patients with head tilt, head turn, and orthotropic subjects was observed in 32 (97%), 50 (86.2%), and 22 (34.3%), respectively (P <0.001). In patients with head tilt and head turn, the mean facial angle was 1.78º ±1.01º and 1.19º ±0.84º, respectively (P = 0.004) and the mean relative facial size was 1.027 ±0.018 and 1.018 ±0.014, respectively (P = 0.018). The frequencies of one-sided nostril compression, cheek compression, face compression, and columella deviation in patients with pure head tilt were found in 19 (58%), 21 (64%), 19 (58%), and 19 (58%) patients, respectively, and in patients with pure head turn the frequencies were observed in 42 (72%), 37 (63%), 27 (47%), and 43 (74%), respectively. All quantitative and qualitative facial asymmetry parameters and facial asymmetry frequencies were significantly higher in head tilt and head turn patients as compared to the control group (P <0.001). Conclusion: All facial asymmetry parameters in patients with head tilt and head turn were significantly higher than orthotropic subjects. The quantitative parameters such as relative facial size and facial angle were significantly higher in patients with pure head tilt than pure head turn. The results revealed that pure head tilt was associated with a higher prevalence of facial asymmetry than pure head turn. [ABSTRACT FROM AUTHOR]

Objective Due to the substantial prevalence of patellofemoral pain syndrome and the importance of quadriceps strengthening in knee rehabilitation, determining the best way to activate and strengthen the patella stabilizing muscles is considered as one of important keys of treatment. The aim of this study is to evaluate the effect of different hip rotations associated with ankle dorsiflexion during maximal straight leg raising (SLR) maneuver in the sitting position on thickness and fibers angle of vastus medialis oblique (VMO) and vastus lateralis (VL) muscles using ultrasonography. Materials & Methods This quasi-experimental study was performed on 40 individuals (healthy group: 20, patellofemoral pain syndrome [PFPS] group: 20). VMO and VL thickness and fiber angle were measured using ultrasonography during maximal SLR in 6 positions: hip internal, hip external, and neutral rotations with and without ankle dorsiflexion. Results In between-group comparison, no significant difference was found for all variables with different SLR maneuvers (P>0.05). In the within-group comparison, hip external rotation compared to other hip positions without ankle dorsiflexion resulted in a significant increase in VMO thickness and fiber angle in both groups (P<0.05). Also, adding ankle dorsiflexion to different hip rotations during SLR significantly increased the thickness and fiber angle of VMO and VL. Conclusion By changing hip rotations with or without ankle dorsiflexion during SLR, the trend of changes in VMO and VL thickness and fiber angle in the two groups followed the same pattern. Moreover, performing SLR in hip external rotation with ankle dorsiflexion can be recommendable for the rehabilitation of PFPS. [ABSTRACT FROM AUTHOR]

Objective: The management of postoperative endodontic pain (PEP) is essential to contemporary endodontic practice. Diclofenac and ibuprofen (IBU) are two of the most widely-used non-steroidal anti-inflammatory analgesics. However, their comparative data are neither sufficient nor conclusive. This prospective randomised clinical trial aimed to compare the analgesic efficacy of diclofenac potassium (DFK) with IBU on PEP in maxillary and mandibular first molars diagnosed with irreversible pulpitis after single-visit non-surgical root canal treatment. Methods: Sixty-four patients were randomised into two groups of DFK (n=32) and IBU (n=32), using the stratified permuted randomisation method, and 61 participants completed the trial. After root canal treatment, patients randomly received IBU 400 mg every 6 hours (n=31) or DFK 50 mg every 8 hours (n=30) for 24 hours. Patients recorded their pain level on 0-100 mm visual analogue scales (VAS) at 2, 4, 6, 12, and 24 hours after the treatment. Recorded VAS scores and the number of pain-free patients (VAS<5) were compared between the two groups. A generalised linear estimation equation model, Chi-Square test, and Mann-Whitney U test were used to analyse the data. Results: The mean overall PEP score was statistically significantly lower in the DFK group than the IBU group with a p value of 0.030. Pain scores at 2 (p=0.034), 4 (p=0.021), and 24 hours (p=0.042) after the treatment were also significantly lower for DFK than IBU. The number of pain-free patients was also significantly higher in the DFK group at 2-hour (p=0.015) and 4-hour (p=0.048) time points and overall (p=0.013) compared to the IBU group. There was no adverse effect observed in either group. Conclusion: Based on the results, taking multi-dose DFK 50 mg by the clock had better analgesic outcomes than multi-dose IBU 400 mg for PEP management. [ABSTRACT FROM AUTHOR]

Background and Aim: The Acceptance Noise Level (ANL) which determines the tolerable noise level while listening to running speech, is related to factors such as hearing loss and speech presentation level. This study aims to investigate the effect of speech presentation level on the ANL in people with unilateral Meniere's Disease (MD) compared to the normal-hearing people. Methods: In this study, 33 people aged 32-60 years with unilateral MD and 38 normal-hearing people aged 20-46 years participated. The ANL growth was evaluated unilaterally at four different speech presentation levels: Most Comfortable Level (MCL), -10 dB lower than the MCL, +10 dB higher than the MCL, and a range between MCL and uncomfortable level. Results: In MD patients, the ANL of the affected ear was significantly different from that of the contralateral ear (p<0.010). Compared to the normal-hearing people, the pattern of ANL growth in MD patients was significantly different, but the ANL growth patterns were similar between the affected and contralateral ears. Conclusion: ANL and its growth pattern are different between the affected and contralateral ears of patients with unilateral MD, but are similar compared to normal-hearing people. Despite the apparently normal hearing thresholds, the performance of the contralateral ear in noise at various speech presentation levels in patients with unilateral MD seems to be similar to that of the affected ear. [ABSTRACT FROM AUTHOR]

Objectives: Sensory processing patterns can be related to children's preferences for various activities. Still, our understanding of how different sensory processing patterns are related to children's participation in leisure activities is fairly limited. Therefore, this study aimed to investigate the association between sensory processing patterns and children's participation in leisure activities. Methods: In this systematic review, the PRISMA (The Preferred Reporting Items For Systematic Reviews And Meta-Analyses) Guidelines were followed. We searched PubMed, Google Scholar, Springer, ProQuest, Scopus, Cochrane Library, Medline, OT Seeker, SID, and Healio databases using the following keywords: "Participation", "leisure", "play", "sensory processing", "sensory integration", "sensorimotor", "sensory", and "children". A total of 5040 articles were found, of which 5027 were eliminated after the review, and finally, 13 articles were included in the study based on the inclusion criteria; 6 of them entered the meta-analysis process. The meta-analysis was performed using CMA software. Results: The meta-analysis of 6 studies illustrated a significant correlation between the energy level and desire to participate in leisure activities, the auditory-visual sensitivity and willingness to participate in leisure activities, the sensory processing patterns and the intensity of involvement in leisure activities, the general sensory processing and desire to participate in leisure activities, the sensory processing patterns and desire to participate in informal activities, the olfactory sensitivity and desire to participate in leisure activities, the auditory filtering and desire to participate in leisure activities, the sensory processing patterns and enjoyment of participation in leisure activities, and finally sensory processing patterns and desire to participate in recreational activities. Discussion: The evidence in articles on sensory processing patterns and participation in play and leisure activities is inadequate. The only conclusion drawn from all patterns of sensory processing is the significant relationship between these patterns and the preference to participate in recreational activities (which is just one of the several leisure activities). [ABSTRACT FROM AUTHOR]

Introduction: This retrospective descriptive study evaluated the Scopus-indexed dental journals and their most-cited documents affiliated with the Middle East and North Africa (MENA) countries from 2011 to 2021. Methods: Dental journals affiliated with MENA countries, their bibliometric indicators (SJR, CiteScore, SNIP, and H-index), and the 101 most cited articles of the considered journals were extracted and studied through descriptive statistics. In addition, the "citation per year" of each top 101 articles was calculated. Spearman's rho test was used for pairwise comparisons of the correlation coefficient values between each two of the considered bibliometric indicators. Results: The number of citations of the 101 most-cited papers ranged from 35 to 203. The mean (SD) citations of studied articles were 61.33 (37.58) and the median was 46. Furthermore, CiteScore had the highest significant correlation with SJR (r = 0.828, P < 0.001). Moreover, the citation per year of the top 101 documents had no significant relationship with any of the journals' bibliometric indicators. Conclusion: Because journal performance and citation rate are multi-dimensional concepts, a single metric cannot express them thoroughly despite correlations between indices. "European Journal of Dentistry" from Turkey, "Saudi Dental Journal" from Saudi Arabia, and "Iranian Endodontic Journal" and "Journal of Lasers in Medical Sciences" both from Iran had the highest ranks in the SCImago portal and the highest scores in bibliometric indices amongst the MENA dental journals. [ABSTRACT FROM AUTHOR]

Introduction: Immobility and limited usage of operated limbs lead to weakness and atrophy of the muscle after anterior cruciate ligament (ACL) reconstruction. However, training programs for preventing biomechanical risk factors such as lower limb alignment and increased muscular contraction are very limited. Thus, the current study was carried out to evaluate the recovery of quadriceps muscle strength and the improvement of knee function using adjuvant electromyographic biofeedback (EMG-BF) after ACL reconstruction. Methods: This prospective randomized controlled trial was conducted among 40 patients (20 = EMGBF group, 20 = Control group) with ACL reconstruction, who were referred to Akhtar Hospital from 2021 to 2022. In the EMG-BF group, EMG BFB was added to the standard rehabilitation protocol, and in the control group, the standard rehabilitation protocol with full postoperative weightbearing, knee brace (zero degree of extension, 90 degrees of flexion), and electrical stimulation with maximal voluntary isometric knee extension was performed. Each group was intervened for 4 weeks and three sessions of 30 minutes per week. It should be noted that each patient participated in 16 outpatient physiotherapy sessions after surgery. Nicholas Hand-Held Dynamometer (HHD) was used for measuring quadriceps strength, and Knee Outcome Survey-Activities of Daily Living (KOS-ADLs) and Knee Outcome Survey Sports Activities Scale (KOS-SAS) questionnaires were used for assessing the knee function. Results: Four weeks after the treatment, the EMG-BF group showed a significant increase in quadriceps strength (P = 0.0001). Quadriceps strength had a significant difference before and after 4 weeks of intervention (P = 0.0001), but in the control group, no significant difference was observed (P = 0.368). The EMG-BF group had a significant increase in KOS-ADLs and KOS-SAS scores after 4 weeks of intervention (P = 0.0001). Conclusion: In our study, isometric strengthening of quadriceps with adjuvant EMG-BF significantly increased the strength of quadriceps and knee function during 4 weeks. EMG-BF is a low risk, low cost, and less invasive intervention and has high safety and adjustment ability. It is a valuable adjuvant method for achieving better functional recovery in a shorter time. [ABSTRACT FROM AUTHOR]

Forward Head Posture (FHP) results in spine malalignment, muscle imbalance and cervical proprioception sensory input impairment. Subjective description of FHP is interpreted differently by clinicians and therefore the FHP is classified as slight, moderate and sever. This study aimed to evaluate balance disorder in individuals with severe forward head posture (FHP). Twenty individuals with severe FHP and 20 controls were enrolled. Dynamic postural stability was assessed in all participants using the Biodex Balance System (BBS) in semi dynamic position with eye open/eye closed conditions. Based on the findings, dynamic postural stability in the sagittal plane was different between the groups (P<0.05). It can be concluded that impairment of dynamic postural stability occurs in individuals with severe FHP. The findings suggest that clinicians take into account the importance of dynamic postural stability assessment in FHP subjects and consider the application of intervention programs for improvement of the dynamic balance. [ABSTRACT FROM AUTHOR]

Background and Aim: Each year, millions of older people experience falling which can cause serious injuries such as broken bones, head injuries, or even death. Since Diabetes Mellitus can disrupt the balance system and increase falling, and given that fear of falling and balance confidence are critical fall-related psychological concerns that can be the risk factors of falls in the diabetic elderly, this study aimed to compare fear of falling and balance confidence of diabetic and non-diabetic older adults in Iran. Methods: Participants were 63 diabetic older patients and 59 non-diabetic peers aged 60 years and over. Data were collected using the Persian versions of falling efficacy scale-international and activities-specific balance confidence-short form questionnaires. In addition, modified Romberg and timed up and go tests were performed to assess subjective balance performance. Results: The scores of falling efficacy scale-international questionnaire and timed up and go test were significantly higher in diabetic group while the scores of activities-specific balance confidence-short form questionnaire were lower (p<0.001). No significant differences were observed in the modified Romberg test scores between two groups. Conclusion: Fear of falling and low balance confidence are more common in diabetic older adults compared to non-diabetic peers. They have poor performance in timed up and go test and have more falls during the last 12 months. [ABSTRACT FROM AUTHOR]

Introduction: Identifying the contributing factors to a specific learning disorder and comparing these factors in different types of this disorder will lead to using more proper interventions in the future. Therefore, this study aimed to compare sensory processing skills and perceived motor competence between three groups of students with specific learning disabilities (reading and writing disorders, math disorders, and combination disorders). Materials and Methods: The present study was a cross-sectional descriptive-analytical study. The participants were 48 children (16 in each group, aged 8-12 years). They were selected from Chaharmahal and Bakhtiari Province, Iran, by the simple convenience sampling method. The participants’ sensory processing was measured with sensory profile 2 and their perceived motor competency with Marsh perceived motor competence questionnaire. Results: The results showed a significant difference between the three groups in the sensory sensitivity, low registration sensory patterns and processing of tactile, and body position senses (P <0.05). However, no significant differences were observed between groups in other components of sensory processing and perceived motor competence (P> 0.05). Conclusion: The results indicate that therapeutic interventions in the group with reading and writing disorders should focus on increasing sensory registration and processing of tactile and body position senses and reducing sensory sensitivity in the mathematical group. [ABSTRACT FROM AUTHOR]