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BACKGROUND Gastroesophageal reflux disease (GERD) is a worldwide disorder with an increasing prevalence. The quality of life (QOL) of the patients may be influenced by reflux disease. Diaphragmatic breathing (DB), as well as aerobic exercise (AE), may improve the symptoms of reflux disease, although it remains a controversial issue. The aim of this study was to compare the effects of AE and DB on QOL and lower esophageal sphincter (LES) pressure of patients with moderate to severe reflux. METHODS This was a case-control study that was conducted for 8 weeks among patients with moderate to severe GERD. The block randomization method was designed to randomize patients into three groups (AE, DB, and control) to achieve equal sample sizes. The control group received omeprazole 20 mg once daily. The other groups, in addition to omeprazole, received AE and DB. QOL and LES pressure were measured before and after the study by Questionary and Manometry method, respectively. RESULTS 75 patients were enrolled in this study. Positive effects of DB on LES pressure was approved (p = 0.001). DB had significantly more effects on QOL than aerobic exercise (p = 0.003). AE can significantly improve QOL in patients (p = 0.02) but no significant change in LES pressure (p = 0.38). There was no change in the control group for both variables. CONCLUSION AE had no effects on LES pressure but can improve QOL of the patients. DB had more effects on QOL than AE, so injured or disable patients with reflux who cannot do AE, can benefit from DB to improve their reflux symptoms.

Avian colibacillosis (AC) is frequently reported from poultry farms in the west of Iran. The aim of the present survey was to evaluate the phylogeny of Escherichia coli isolated from AC through the Clermont triplex protocol and gyrA gene sequencing. One hundred and fifty fresh carcasses suspected of having died from colibacillosis were sampled. The specimens were examined for E. coli isolation and identification. The extracted DNA repertoire of the isolates was subjected to phylogenetic analysis using Clermont triplex PCR. A DNA fragment of 1.8 kbp of the gyrA gene was amplified from a representative of each phylogroup or subgroup and the final product was sequenced to depict a phylogenetic tree. In general, among 119 E. coli isolates, 31.93%, 6.72%, 34.45%, and 23.52% were clustered in phylogroups A, B1, B2, and D, respectively. The phylogenetic assignment of the isolates based on the phylogenetic tree was completely uniform with the results of the triplex method. The outcome represents the segregation of avian pathogenic E. coli isolates to various phylogroups in the region. Moreover, the precise cluster analysis of E. coli based on gyrA sequencing confirms this method as a robust candidate for phylotyping of the bacterium.

Background: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders that can disturb patients’ respiratory indices. Proton pump inhibitors (PPIs) such as omeprazole are currently the most common treatment in the patients. PPI-refractory GERD is a clinical problem constituting around 30% of patients with GERD. Objectives: The aim of this study was to investigate the effects of diaphragmatic breathing (DB) and omeprazole on respiratory indices (RI) and diaphragmatic excursion (DEX) in patients with GERD. Methods: This is a clinical trial conducted for eight weeks among 40 patients with severe GERD in Tehran in 2018. The block randomization method was designed to randomize 40 patients into two groups (DB and control) that resulted in equal sample sizes. The control group received omeprazole 20 mg once daily, and the DB group, in addition to omeprazole, performed DB. Respiratory indices, including (Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), Peak Expiratory Flow (PEF)), and DEX were evaluated before, immediately, and six weeks after the end of intervention by spirometry and ultrasonography; respectively. Results: There was no significant difference in the RI and DEX before the intervention between groups. FVC (P = 0.04) and PEF (P = 0.02) significantly changed in the control group, but FEV1 (P = 0.001), FVC (P = 0.002), PEF (P = 0.001) and DEX (0.001) significantly changed after DB. There was a significant difference in terms of RI between before and followed up in DB. Conclusions: Diaphragmatic breathing with omeprazole had more effects on RI and DEX than omeprazole alone. The positive effects of DB remain at least six weeks after the end of the intervention.

Background Altered scapular muscle activity is associated with abnormal scapular motions and shoulder pain. Hence, quantification of these activities is a challenging issue. Objectives: The purposes of this study were to establish the reliability of measuring levator scapula muscle thickness and to examine how thickness of this muscle changes with contraction. Methods Twenty-one asymptomatic individuals (mean age 22.29 ± 2.17 years) participated in this study. Three separate ultrasound images of the levator scapula muscle were captured at the neck-shoulder junction at rest and during a loaded isometric contraction. The procedures were repeated twice, four to seven days apart to establish intra-rater test-retest reliability. Interclass correlation coefficients (ICC) and standard error of measurement (SEM) were used to determine the reliability, and a paired t-test was performed to examine the difference in muscle thickness between two conditions. Results The results demonstrated that intra-examiner reliability was good at rest (ICC = 0.88, SEM = 1.16 mm) and excellent during loaded isometric contraction (ICC = 0.95, SEM = 0.91 mm). Furthermore, the thickness of levator scapula muscle significantly increased from rest to the loaded isometric contraction (Effect size = 1.99, P Conclusion This study demonstrates that the thickness of the levator scapula muscle can be measured reliably at the neck-shoulder junction. Furthermore, ultrasound measures can reliably detect changes in muscle thickness from rest to a contracted state. Therefore, if the need exists to evaluate muscle morphology before and after any treatment strategy, thickness measurement of levator scapula can be determined reliably using ultrasound.

As one of the most common work-related musculoskeletal disorders and postural deviations, forward head posture (FHP), is considered to lead to muscle imbalance.The aim of this study is to investigate the bilateral cross-sectional area (CSA) of the deep neck flexor muscles at rest and during five stages of the craniocervical flexion (CCF) test in individuals with FHP and the controls with normal head posture.Eighteen students with FHP and 18 controls with normal head posture, all females aged 18-35 years, participated in this study. Participants were categorized into two groups based on their craniovertebral angle. The CSA of the deep neck flexors was measured using ultrasonography while participants lay supine on the table with a pressure biofeedback unit placed under their necks in order to let the examiner measure the CSA of the muscles during rest and five stages of the CCF test including 22, 24, 26, 28, and 30 mmHg of the pressure biofeedback unit.A significant effect of contraction level was observed in both groups, indicating significant increases of the CSA of the deep neck flexors during contraction (F = 64.37, P 0.001). No significant difference was evident for the CSA of the deep neck flexors between the groups, although the increase in the CSA of the deep neck flexors was up to 28 mmHg in the normal head posture group compared to 26 mmHg in the FHP group.The results of the present study showed no significant difference between the performance of the deep neck flexors during the CCF test in FHP and normal head posture individuals, which challenge the common belief of the deep neck flexors weakness in individuals sustaining FHP.

Background: Externalizing behavior in deaf children causes many psychological problems for their parents. Aggression and rule breaking behaviors in children with severe hearing loss may cause psychological problems in parents and in managing children's behavior. Consequently, the present study aimed at investigating the effect of parental behavioral training of mothers on reducing the externalized behaviors (aggression and rule breaking behavior) of their 9- to 10- year old children with severe hearing loss. Methods: This was an experimental study with pretest, posttest, and a control group. The research population included all students with severe hearing loss and their mothers. Thus, 30 mothers whose children had the most severe hearing loss were selected as our main sample among 80 mothers who had completed the Child Behavior Checklist. Then, they were placed into the experimental (n=15) and control groups (n=15) after being matched based on age, educational level, and socioeconomic status. The research tool was Child Behavior Checklist-Persian Version. The parental behavior training was provided for the experimental group in nine 90- minute sessions. Results: The results of the present study indicated the effectiveness of experimental treatment on decreasing the aggressive behaviors of children of mothers in the experimental group compared to mothers of the control group (p=0.001). Moreover, the results revealed a decrease in rule breaking behaviors (p= 0.007) in children of mothers of the experimental group compared to mothers of the control group. Conclusion: Parents’ behavioral training is important in decreasing the aggressive and offensive behaviors in children with severe hearing loss who are at risk of behavioral problems. Furthermore, some research has highlighted the necessity of such trainings for parents of these children. Thus, the present study, emphasizing the importance of childhood problems, found that mothers’ behavioral training could prevent behavioral problems of school-aged children with hearing loss and reduce the recurrence of such problems.

Aims: The objective of this study was to investigate and compare the cross-sectional area (CSA) of deep neck flexor muscles (DNFs) in individuals with chronic non-specific neck pain (CNNP) and healthy controls while performing a five-stage cranio-cervical flexion (CCF) test.Methods: Twenty individuals with CNNP and 20 healthy controls voluntarily participated in this case–control study. Cross-sectional area of DNFs was measured using ultrasonography while the participants lay in supine position to perform the CCF test. The five stages of the CCF test were determined by a pressure biofeedback tool. Neck disability index and pain were also assessed. Repeated measures analysis of variance was used to interpret the yielded data.Results: A significant difference was observed in the CSA of DNFs between individuals with CNNP and healthy controls at the pressure of 24 mm (p = .009) of the CCF test. The CSA of DNFs significantly changed through increasing the CCF test pressure. No significant differences w...

Objective Neck muscles provide more than 80% of the mechanical stability of the cervical spine. Deep neck flexor muscles including Longus Colli (LC) and longus capitis (LCA) play an important role in maintaining the cervical spine stability. Patients with chronic neck pain suffer from weakness and atrophy of neck flexor muscles. Ultrasonography measurement of muscle dimensions provides the ability to objectively assess muscle atrophy or hypertrophy. Therefore, the aim of this study was to evaluate the reliability of measurement of the cross-sectional area of LC and LCA muscles in five stages of craniocervical flexion (CCF) test utilizing ultrasonography. Methods & Materials A total of 10 individuals including 5 patients suffering from chronic nonspecific neck pain and 5 healthy controls voluntarily participated in this study. The cross-sectional areas of LC and LCA muscles were measured at the level of thyroid cartilage during five stages while the subjects performed CCF test using a real-time ultrasound device. Two images were taken on the same day with an hour interval to assess the within-day reliability, and another image taken a week later to determine between-day reliability. SPSS was used to analyze data. Results The ICC for within-day and between-day reliability in healthy individuals and patients were 0.91, 0.88 and 0.90, 0.86, respectively. The average standard error of measurement with the minimum of 0.03 and the maximum of 0.05 was obtained. Conclusion Ultrasonography is a reliable method to measure the cross-sectional area of LC and LCA muscles both in healthy individuals and patients with chronic neck pain during five stages of the CCF test.

BACKGROUND AND OBJECTIVES Cervicogenic headache (CGH) originated from impaired cervical musculoskeletal structures. Dysfunction of deep neck flexor muscles has been reported in CGH subjects. The purpose of this study was to assess relationship between the size of these muscles and headache laterality in CGH subjects. MATERIAL AND METHOD A cross sectional single blind study designed to investigate 37 CGH subjects compared with 37 healthy controls. Longus colli (LC) muscle Cross Sectional Area (CSA) in both sides was measured in supine position utilizing diagnostic ultrasonography. RESULTS The mean CSA of LC muscle in healthy subjects was 0.74 ± 0.06 cm2 and in patients suffering from CGH was 0.74 ± 0.06 cm2 in left and 0.75 ± 0.06 cm

Objective The purpose of this study was to assess muscle thickness changes in the deep and superficial abdominal muscles, during sitting on stable and unstable surfaces in subjects with and without chronic low back pain (CLBP). Method A cross-sectional study was conducted involving 40 participants (20 CLBP and 20 healthy). Ultrasound imaging was used to assess changes in the thickness of the Transversus abdominis (TrA), Internal Oblique (IO), Rectus abdominis (RA) and External oblique (EO) muscles. Muscle thickness under two different sitting postures; (sitting on a chair and sitting on a Swiss ball), was normalized to actual muscle thickness at rest in the supine lying position and was expressed as a percentage of thickness change of muscles. Result The results showed significantly greater thickness changes in RA muscle in the CLBP patients compared to the healthy subjects, during both stable and unstable sitting positions. Also, significantly lower thickness changes in TrA muscle was observed in subjects with CLBP compared to those without CLBP, during unstable sitting position. Conclusion There was an imbalance between the automatic activity of TrA and RA muscles in the subjects with CLBP, compared to the pain-free controls, during an unstable sitting position. Therefore, it is necessary to pay attention, to the altered automatic activity of the abdominal muscles while utilizing a Swiss ball, for rehabilitation of subjects with CLBP.

OBJECTIVE The purpose of this study was to determine the prevalence of and risk factors for neck pain in dentists of Tehran province and to analyze the association of neck pain with individual and occupational characteristics. DESIGN Following ethical approval, a cross sectional study was conducted on 300 randomly selected dentists at Tehran city. Different questionnaires were used to collect personal and occupational characteristics as well as the prevalence and risk factors of neck pain. The Iranian validated version of visual analogue scale and neck disability questionnaires were also used to assess the pain intensity and functional disability of neck, respectively. RESULTS Point, last month, last year and lifetime prevalence of neck pain were 19.3%, 27.3%, 29.9% and 34.7%, respectively. The prevalence of neck pain was significantly correlated with regular exercise, general health condition and having an assistant (P< 0.05 in all instances) and was not significantly correlated with body mass index, age and gender. Prolonged sitting, awkward postures and repeated movements were the most significant aggravating factors. CONCLUSIONS Results indicated that the prevalence of neck pain in dentists appears to be high. Therefore, further studies on different preventive strategies in dentists' population seem necessary.

[Purpose] This study compared the effectiveness of stabilization and McKenzie exercises on pain, disability, and thickness of the transverse abdominis and multifidus muscles in patients with nonspecific chronic low back pain. [Subjects] Thirty patients were randomly assigned into two groups: the McKenzie and stabilization exercise groups. [Methods] Before and after intervention, pain, disability, and thickness of the transverse abdominis and multifidus muscles were evaluated by visual analogue scale, functional rating index, and sonography, respectively. The training program was 18 scheduled sessions of individual training for both groups. [Results] After interventions, the pain score decreased in both groups. The disability score decreased only in the stabilization group. The thickness of the left multifidus was significantly increased during resting and contracting states in the stabilization group. The thickness of the right transverse abdominis during the abdominal draw-in maneuver, and thickness of the left transverse abdominis during the active straight leg raising maneuver were significantly increased in the stabilization group. The intensity of pain, disability score, thickness of the right transverse abdominis during the abdominal draw-in manouver, and thickness of the left transverse abdominis during active straight leg raising in the stabilization group were greater than those on the Mackenzie. [Conclusion] Stabilization exercises are more effective than McKenzie exercises in improving the intensity of pain and function score and in increasing the thickness of the transverse abdominis muscle.

Summary In this study, the reliability of the longus colli muscle (LCM) size was assessed in a relaxed state by a real time ultrasonography (US) device in a group of healthy subjects and a group of patients with chronic neck pain. Fifteen healthy subjects (19–41years old) and 10 patients with chronic neck pain (27–44years old) were recruited for the purpose of this study. LCM size was measured at the level of thyroid cartilage. Two images were taken on the same day with an hour interval to assess the within day reliability and the third image was taken 1week later to determine between days reliability. Cross sectional area (CSA), anterior posterior dimension (APD), and lateral dimension (LD) were measured each time. The shape ratio was calculated as LD/APD. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were computed for data analysis. The ICC of left and right CSA for within day and between days reliability in healthy subjects were (0.90, 0.93) and (0.85, 0.82), respectively. The ICC of left and right CSA for within day and between days reliability in patients with neck pain were (0.86, 0.82) and (0.76, 0.81), respectively. The results indicated that US could be used as a reliable tool to measure the LCM dimensions in healthy subjects and patients with chronic neck pain.

Objective This article presents a review of the literature concerning size measurement of cervical muscles using real-time ultrasound imaging (RUSI) in patients with neck pain and in healthy populations. Methods A literature search from 1996 to December 2009 making use of Science Direct and PubMed databases was conducted. Medical Subject Headings and other terms were as follows: ultrasonography , cervical , muscle , neck , size , pain , validity , reliability , neck pain , and healthy subjects . We included studies using RUSI for assessing cervical paraspinal muscles both in healthy subjects and in patients with neck pain. We assessed muscles investigated and the reliability and validity of the method used. Results The literature search yielded 16 studies. Twelve (75%) studies assessed the posterior muscles, whereas in the remaining 4 (25%), the anterior muscles were studied. Three studies quantified the size of the muscles during contraction; 3 assessed the relationship between cross-sectional area, linear dimensions, and anthropometric variables; 1 evaluated the training-induced changes in muscle size; 1 assessed the differences in muscle shape and cross-sectional area of cervical multifidus between patients with chronic neck pain and controls; 8 studies looked at the reliability of using RUSI in patients with neck pain or healthy subjects; and 3 studies evaluated the validity of RUSI compared with magnetic resonance imaging. Conclusions This literature review has shown that there are not sufficient studies for assessing neck muscles with RUSI. It seems that using constant landmarks, knowledge of anatomy and function of target muscle, and a proper definition of muscle borders can help to take a clear image. Standardized position of the subject, correct placement of the transducer, and using multiple RUSI for statistical analyses may improve results.

The current study was conducted to explore the relationship between suicidal ideas, depression, anxiety, resiliency, daily stresses and mental health among university students. 265 students of Tehran University were studied. They were asked to answer the Beck's depression and anxiety, suicidal ideation, mental health, daily stresses and resiliency questioners. Pearson correlation coefficient and stepwise regression analyses were used for the data analysis. Suicidal ideations had a significant and negative relationship with resiliency. Anxiety, depression, mental health and daily stresses had a positive relationship with suicidal ideations. Regression analysis revealed that depression had the most contribution in predicting suicidal ideations while anxiety, mental health, Resiliency, and daily stresses were the next contributing factors, respectively. These variables could predict 21 percent of suicidal ideations altogether. Psychological problems and mental health issues and other factors such as resiliency and daily stresses play an important role in suicidal ideations.

The present study aimed at the comparison of the prevalence of ADHD and also the components of the disorder (hyperactivity’attention deficit and impulsivity) among patients with substance use disorder and normal people. To achieve the goal‚ 85 patients were selected among clients referring to addiction treatment centers in Tehran city‚ and 85 normal subjects were selected using at-hand sampling. Data from the subjects were collected using the Adult Questionnaire – Childhood ADHD Symptoms Rating Scale (AQ- CASRS). Data were analyzed using T-test: Results indicated there existed a significant difference between patients with substance use disorder and normal people in terms of their total scores in ADHD and its components: patients with substance use disorder reported more problems and symptoms compared to normal people.

A pattern of musculoskeletal impairment inclusive of upper cervical joint dysfunction, combined with restricted cervical motion and impairment in muscle function, has been shown to differentiate cervicogenic headache from migraine and tension-type headache when reported as single headaches. It was questioned whether this pattern of cervical musculoskeletal impairment could discriminate a cervicogenic headache as one type of headache in more complex situations when persons report two or more headaches. Subjects with two or more concurrent frequent intermittent headache types ( n = 108) and 57 non-headache control subjects were assessed using a set of physical measures for the cervical musculoskeletal system. Discriminant and cluster analyses revealed that 36 subjects had the pattern of musculoskeletal impairment consistent with cervicogenic headache. Isolated features of physical impairment, e.g. range of movement (cervical extension), were not helpful in differentiating cervicogenic headache. There were no differences in measures of cervical musculoskeletal impairment undertaken in this study between control subjects and those classified with non-cervicogenic headaches.

Jull G, Amiri M, Bullock-Saxton J, Darnell R & Lander C. Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: Subjects with single headaches. Cephalalgia 2007; 27:793-802. London. ISSN 0333-1024 Musculoskeletal disorders are considered the underlying cause of cervicogenic headache, but neck pain is commonly associated with migraine and tension-type headaches. This study tested musculoskeletal function in these headache types. From a group of 196 community-based volunteers with headache, 73 had a single headache classifiable as migraine (n = 22), tension-type (n = 33) or cervicogenic headache (n = 18); 57 subjects acted as controls. Range of movement, manual examination of cervical segments, cervical flexor and extensor strength, the cranio-cervical flexion test (CCFT), cross-sectional area of selected extensor muscles at C2 (ultrasound imaging) and cervical kinaesthetic sense were measured by a blinded examiner. In all but one measure (kinaesthetic sense), the cervicogenic headache group were significantly different from the migraine, tension-type headache and control groups (all P < 0.001). A dicriminant function analysis revealed that collectively, restricted movement, in association with palpable upper cervical joint dysfunction and impairment in the CCFT, had 100% sensitivity and 94% specificity to identify cervicogenic headache. There was no evidence that the cervical musculoskeletal impairments assessed in this study were present in the migraine and tension-type headache groups. Further research is required to validate the predictive capacity of this pattern of impairment to differentially diagnose cervicogenic headache.

Objective The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain is yet to be demonstrated. The purpose of this study was to assess the effect of two exercise programs; craniocervical flexion (CCF) and cervical flexion (CF), on flexor muscles dimensions in patients with chronic neck pain. Methods Following ethical approval, 60 patients were randomly assigned into either a CCF group or a CF group. Patients in the CCF group were given CCF exercises and those in the CF group received CF exercises. All patients received interventions for a period of ten weeks. Pain intensity and functional disability were assessed using numerical pain rate scale and neck disability index, respectively. Dimensions of longus colli (LC) and sternoclidomastoid (SCM) muscles were measured using ultrasonography (US). All measurements were taken before and after interventions. Results Following intervention, the CCF group demonstrated a significant increase in LC muscle dimensions including cross sectional area, width and thickness compared with the CF group. A statistically significant increase was found on SCM thickness in the CF group. Following intervention, SCM thickness measurement in the CCF group showed no significant changes. Statistically significant decrease on pain intensity and disability were also found in both groups. Conclusion Present findings demonstrated that craniocervical flexion program which specifically recruiting deep cervical flexor muscles increased LC muscle dimension significantly and CF program as an endurance training program increased SCM thickness.

Most external measurement devices do not allow ready differentiation of upper cervical flexion and extension from total cervical movement. This study investigated the "within" and "between-days" repeatability of measurement focused on upper cervical flexion and extension in three dimensions using the Fastrak, a 3-Space measurement system, on 21 subjects. To localize the measurement, one sensor of the Fastrak was centered over the subject's forehead and the other was held manually over the C2 spinous process. Three repetitions of upper cervical flexion (nod of the head) and extension (chin lift) were performed in each trial. Two trials were performed on the first day with the third trial one-week later. Results indicated high levels of repeatability for "within" and "between-days" measurements (ICC2,1: 0.97 to 0.99). The mean ranges of upper cervical flexion and extension were 15.03° ± 2.80° and 23.32° ± 4.20° respectively, were accompanied by a small amount of lateral flexion and rotation, predomi...

Validation of 2 self-report questionnaires.To evaluate the internal consistency, reliability, and construct validity of the Persian versions of the fear avoidance beliefs questionnaire (FABQ) and the Tampa Scale of Kinesiophobia (TSK) in patients with acute and chronic neck pain.The FABQ and TSK are 2 important measures to evaluate fear of pain and fear avoidance beliefs in patients with spinal pain. To date, the psychometric properties of these questionnaires have not been demonstrated in Persian-speaking patients with neck pain in Iran.One hundred sixty-six patients with acute and chronic neck pain participated in the study. The construct validity of the questionnaires was evaluated by measuring convergent and known-groups validity. The visual analogue scale measure of pain, neck disability index, hospital anxiety and depression scale, and the physical (PCS-12) and mental (MCS-12) summary scores of the Short Form health survey (SF-12) were used to test construct validity of the Persian FABQ and TSK. In addition, 50 randomly selected patients with chronic neck pain were asked to complete the questionnaires 48 hours later for the second time.Cronbach α coefficient for the FABQ and TSK in patients with acute and chronic pain was in the range from 0.77 to 0.92 and 0.77 to 0.78, respectively. The Persian FABQ and TSK showed satisfactory test-retest reliability with intraclass correlation coefficient of more than 0.80. There were moderate to strong correlations between the Persian FABQ and TSK scores and the neck disability index (r = 0.44-0.55), Depression subscales of the hospital anxiety and depression scale (r = 0.42-0.48), and PCS-12 (r =-0.34 to -0.62).The Persian FABQ and TSK have acceptable reliability and validity for measuring pain related fear and avoidance beliefs among Persian-speaking patients with acute and chronic neck pain. However, considering the study limitations, the findings should be interpreted with caution.3.

A 27-year-old man was admitted with tremulousness, diaphoresis, tachypnea (28 breaths/min), full-body rigidity, irritability, paranoia, and auditory and visual hallucinations 2 days after stopping long-term gamma-hydroxybutyrate (GHB) and 8 hours after stopping alcohol intake. He received intravenous fluids and tapering dosages of lorazepam to control agitation and rigidity, and recovered with no significant sequelae after 8 days. Abrupt cessation of GHB after high-dosage abuse can precipitate a clinically significant withdrawal syndrome. Lorazepam should be considered for treatment of GHB withdrawal. Concomitant alcohol abuse may mask early GHB withdrawal symptoms and exacerbate withdrawal.

Background Ultrasound (US) imaging has been considered as a non-invasive technique to measure thickness and estimate relative abdominal muscle activity. Although some studies have assessed the reliability of US imaging, no study has assessed the reliability of US measurement of automatic activity of abdominal muscles in positions with different levels of stability in participants with chronic low back pain (cLBP). The purpose of this study was to investigate within-day and between-days reliability of US thickness measurements of automatic activity of the abdominal muscles in asymptomatic participants and within-day reliability in those with cLBP. Methods A total of 20 participants (10 with cLBP, 10 healthy) participated in the study. The reliability of US thickness measurements at supine lying and sitting positions (sitting on a chair, sitting on a gym ball with both feet on the ground or lifting one foot off the floor) were assessed. We evaluated within-day reliability in all participants and between-days reliability in asymptomatic participants. Results We found high ICC scores (0.85-0.95) and also small SEM and MDC scores in both groups. The reliability of the measurements was comparable between participants with and without LBP in each position but the SEMs and MDCs was slightly higher in patient group compared with healthy group. It indicates high intra-tester reliability for the US measurement of the thickness of abdominal muscles in all positions. Conclusion US imaging can be used as a reliable method for assessment of automatic activity of abdominal muscles in positions with low levels of stability in participants with and without LBP.

Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M, Ortega-Santiago R, Fernandez-de-las-Penas C: Ultrasound assessment of bilateral longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med Rehabil 2011;90:293Y301. Objective: The aim of this study was to investigate bilateral differences in the cross-sectional area (CSA) and shape ratio of the longus colli muscle between subjects with mechanical neck pain and healthy controls. Design: A case-control cohort study was conducted. Bilateral ultrasound images of the longus colli muscle at the thyroid (C5YC6) level were conducted in 20 patients with mechanical bilateral chronic neck pain and 20 controls by an assessor blinded to the subjects' condition. CSA, anterior-posterior dimension (APD), lateral dimension (LD), and shape ratio (LD/APD) were measured. Results: The intraclass correlation coefficients (3,1) were above 0.86 for within-day and above 0.81 for between-day intraexaminer reliability. Patients with mechanical neck pain showed bilateral smaller CSA (P G 0.001) and APD (P = 0.004) as compared with controls. Muscle shape and LD were not different between groups (P = 0.092 and P = 0.963, respectively). Women exhibited smaller bilateral CSA as compared with men (P G 0.01). CSA was negatively associated with self-reported disability, whereas APD was negatively associated with intensity of neck pain: the greater the self-reported disability or the pain intensity, the smaller the bilateral CSA or APD of the longus colli muscle. Conclusions: The longus colli muscle exhibited smaller bilateral CSA and APD, but not LD and shape ratio, in subjects with bilateral chronic neck pain as compared with healthy controls. Reduced CSA was negatively associated with self- reported disability and APD was negatively associated with the intensity of pain.

The purpose of this study was to investigate the changes in the thickness of the transversus abdominis (TrA) and internal oblique (IO) muscles in three sitting postures with different levels of stability. The technique of ultrasound imaging was used for individuals with and without chronic low back pain (LBP). A sample of 40 people participated in this study. Subjects were categorised into two groups: with LBP (N = 20) and without LBP (N = 20). Changes in the thickness of tested muscles were normalized under three different sitting postures to actual muscle thickness at rest in the supine lying position and were expressed as a percentage of thickness change. The percentage of thickness change in TrA and IO increased as the stability of the sitting position decreased in both groups. However, the percentages of thickness change in all positions were less in subjects with LBP. There was a significant difference in thickness change in TrA when sitting on a gym ball between subjects with and without LBP but no difference was found when sitting on a chair. There was no significant difference in thickness change in IO in all positions between the two groups. Our findings indicate that difference in the percentage of thickness change in TrA between subjects with and without LBP increases as the stability of sitting position decreases.

Most external assessments of cervical range of motion assess the upper and lower cervical regions simultaneously. This study investigated the within and between days reliability of the clinical method used to bias this movement to the upper cervical region, namely measuring rotation of the head and neck in a position of full cervical flexion. Measurements were made using the Fastrak measurement system and were conducted by one operator. Results indicated high levels of within and between days repeatability (range of ICC2,1 values: 0.85-0.95). The ranges of axial rotation to right and left, measured with the neck positioned in full flexion, were approximately 56% and 50%, respectively of total cervical rotation, which relates well to the proportional division of rotation in the upper and lower cervical regions. These results suggest that this method of measuring rotation would be appropriate for use in subject studies where movement dysfunction is present in the upper cervical region, such as those with cervicogenic headache.