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Objectives: Frozen shoulder (adhesive capsulitis) is a common musculoskeletal disease that appears with a number of symptoms such as pain and constrained active and passive motions of the shoulder. Frozen shoulder mainly affects middle-aged adults. Local corticosteroids injection, oral corticosteroid, Platelet-Rich Plasma (PRP), NSAIDs, and physiotherapy may alleviate the symptoms. The aim of this study is to compare the efficacies of corticosteroid injection and PRP in treating frozen shoulder. Methods: A quasi-experimental research was performed on patients with frozen shoulder; to this end, 32 male and 109 female patients were enlisted in the study. The patients were divided randomly into two groups: those receiving (a) PRP and (b) corticosteroid injection. Results: No significant relation was noticed between the two groups after 12 weeks according to a range of motions in flexion ([Formula: see text] = 0.300), abduction ([Formula: see text] = 0.133), external rotation ( [Formula: see text] = 0.100), and internal rotation ([Formula: see text] = 0.206). In addition, no significant difference between pain and function scores was detected ([Formula: see text] = 0.103, 0.100). Conclusion: Based on our investigation, both corticosteroid injection and PRP are effective in treating adhesive capsulitis, and there is no notable difference in the effectiveness of these two treatment modalities in patients with frozen shoulder.

Nephrotic syndrome (NS) is associated with metabolic perturbances including profound dyslipidemia characterized by hypercholesterolemia and hypertriglyceridemia. A major underlying mechanism of hypertriglyceridemia in NS is lipoprotein lipase (LPL) deficiency and dysfunction. There is emerging evidence that elevated angiopoietin-like protein 3 (ANGPTL3), an LPL inhibitor that is primarily expressed and secreted by hepatocytes, may be in part responsible for these findings. Furthermore, there is evidence pointing to the contribution of ANGPTL3 to the pathogenesis of proteinuria in NS. Therefore, we hypothesized that inhibition of hepatic ANGPTL3 by RNA interference will ameliorate dyslipidemia and other symptoms of NS and pave the way for a new therapeutic strategy. To this end, we used a subcutaneously delivered, GalNAc (N-Acetylgalactosamine)-conjugated small interfering RNA (siRNA) to selectively target and suppress liver Angptl3 in rats with puromycin-induced NS, which exhibits clinical features of NS including proteinuria, hypoalbuminemia, hyperlipidemia, and renal histologic abnormalities. The study demonstrated that siRNA-mediated knockdown of the liver Angptl3 relieved its inhibitory effect on LPL and significantly reduced hypertriglyceridemia in nephrotic rats. This was accompanied by diminished proteinuria and hypoalbuminemia, which are the hallmarks of NS, and significant attenuation of renal tissue inflammation and oxidative stress. Taken together, this study confirmed the hypothesis that suppression of Angptl3 is protective in NS and points to the possibility that the use of RNA interference to suppress hepatic Angptl3 can serve as a novel therapeutic strategy for NS. SIGNIFICANCE STATEMENT The current standard of care for mitigating nephrotic dyslipidemia in nephrotic syndrome is statins therapy. However, the efficacy of statins and its safety in the context of impaired kidney function is not well established. Here, we present an alternate therapeutic approach by using siRNA targeting Angptl3 expressed in hepatocytes. As the liver is the major source of circulating Angptl3, siRNA treatment reduced the profound hypertriglyceridemia in a rat model of nephrotic syndrome and was also effective in improving kidney and cardiac function.

Introduction Sprengle deformity is the most common congential anomaly of shoulder complex that is the result of scapular placement in cephalad abnormal position. The purpose of this study is the evaluation of clinical and radiological results of vertical corrective scapular osteotomy and comparision of these results with previous studies. Methods We retrospectively reviewed the results of the vertical corrective scapular osteotomy (VSO) with or without clavicular osteotomy and wake-up test in 31 consecutive patients at an average duration of follow up of 30 month (6 month-15 years). 22 patients were girls and 9 were boys. The average age of the patients was 7.3 years (3-13) at the time of surgery. We evaluated the clinical and radiological results of this method in last fallow-up. No funding was used for this study and there are no conflicts of interest. Results 31 surgical procedures were performed. All osteotomies were healed. No neurovascular complication. Postoperative the mean shoulder flexion and abduction were improved 30 and 36° respectively (p, Highlights • Sprengle deformity is the most common congential anomaly of shoulder complex. • Surgical options can vary from excision of the angle to some major procedures such as subtotal scapulectomy. • Vertical scapular osteotomy (VSO) is considered a relocation procedure that can provide cosmetic and functional improvement. • More cosmetic scapular lowering with little chance of neurovascular problems can be achieved after VSO. • Scapular rotation can be corrected using this technique.

Determination of seismic design forces of structures is performed by the building codes usually using response reduction (or behaviour) factors that incorporate indeterminacy and ductility capacity of lateral bearing systems. In this procedure story drifts are checked as a final design step approximately preventing stories from assuming excessive ductility demands, or seismic damage. If this procedure is reversed, a more logical seismic design approach may be developed by starting with a ductility-controlled procedure. It is the incentive of this research in which by using a large number of earthquakes, first nonlinear acceleration spectra are developed for different levels of ductility demand. Then an energy-based modal procedure is developed in which the system ductility demand is distributed between the important vibration modes based on their contribution. Finally, the developed method is applied to seismic design of several buildings selected from both regular and irregular structural systems. Comparison with a sample code design establishes success of the method in developing a more rational seismic design.

Twin screw extrusion at speeds exceeding several thousand rotations per minute (RPM) has the potential to provide extreme shear typically required to break up aggregates and provide good dispersion in polymer nanocomposites. In this work, a novel twin screw extruder with ultra-high screw speed capability has been used to compound the polystyrene (PS) with organically modified nanoclay without using any compatibilizer. The rheological properties and the morphology of the nanocomposites were investigated and compared with simulation after compounding. Screw profiles imparting more and less aggressive mixing were compared over a range of screw speeds from 400 to 4000 RPM. Morphological characterization revealed the necessity of intense shear stress for achieving intercalation and exfoliation when chemical interactions between filler and matrix are unfavorable. The nanocomposites exhibited greater elasticity indicating reinforcement up to a critical screw speed for each screw profile, but further increasing the screw speed resulted in significant polymer degradation, and thus lower viscosity and storage modulus. Moreover, based on calculations of the theoretical adhesion force between the organoclay layers and the shear stress imparted through mixing, the optimized screw speed for a specific screw profile was determined that would overcome lamellar adhesion to form exfoliated nanocomposites, while minimizing the effect of degradation. The resulting model could be extended to any well-defined extruder system as well as other agglomerated nanofillers.

Background: Moral reasoning is a vital skill in the nursing profession. Teaching moral reasoning to students is necessary toward promoting nursing ethics. Objectives: The aim of this study was to compare the effectiveness of problem-based learning and lecture-based methods in ethics education in improving (1) moral decision-making, (2) moral reasoning, (3) moral development, and (4) practical reasoning among nursing students. Research design: This is a repeated measurement quasi-experimental study. Participants and research context: The participants were nursing students in a University of Medical Sciences in west of Iran who were randomly assigned to the lecture-based (n = 33) or the problem-based learning (n = 33) groups. The subjects were provided nursing ethics education in four 2-h sessions. The educational content was similar, but the training methods were different. The subjects completed the Nursing Dilemma Test before, immediately after, and 1 month after the training. The data were analyzed and compared using the SPSS-16 software. Ethical considerations: The program was explained to the students, all of whom signed an informed consent form at the baseline. Findings: The two groups were similar in personal characteristics (p > 0.05). A significant improvement was observed in the mean scores on moral development in the problem-based learning compared with the lecture-based group (p < 0.05). Although the mean scores on moral reasoning improved in both the problem-based learning and the lecture-based groups immediately after the training and 1 month later, the change was significant only in the problem-based learning group (p < 0.05). The mean scores on moral decision-making, practical considerations, and familiarity with dilemmas were relatively similar for the two groups. Conclusion: The use of the problem-based learning method in ethics education enhances moral development among nursing students. However, further studies are needed to determine whether such method improves moral decision-making, moral reasoning, practical considerations, and familiarity with the ethical issues among nursing students.

Background The purpose of this study was to determine the biomechanical changes after first dorsal compartment release and after Z-plasty of the first dorsal compartment with respect to the excursion and displacement of the abductor pollicis longus and extensor pollicis brevis tendons. Materials and methods Six fresh frozen cadaveric hand and forearms were obtained and the tendons of the abductor were exposed and separated from surrounding tissues through a palmar incision and tenotomized at the musculotendinous junction. The excursion and displacement of the abductor pollicis brevis and flexor pollicis brevis tendons were measured for all six cadaveric hands. Results Increases in tendon excursion were observed in both the abductor pollicis longus (29%) and extensor pollicis brevis (30%) while these observations after Z-plasty were 0.04% for abductor pollicis longus and 0.07% for extensor pollicis brevis. With the use of the modified Elftman curve for the Lengths, tension relationship and Brand's data for resting fiber length we found that 1 cm increase of The excursion of the APL and EPB will decrease tension %65 and %80 respectively. There was also a 12.2-mm displacement of the tendons after release and 4.8 mm displacement after z-plasty of the compartment. Conclusion It seems that Procedures such as enlargement plasty of Kapandji or Z-plasty will increase the size of the compartment but will not change the biomechanical behaviors of the tendons significantly., Highlights • One of the common causes of wrist and hand pain or disability is the first extensor compartment entrapment. • Surgical approaches for de Quervain tenosynovitis may lead to volar subluxation or excursion of the APL and EPB tendons. • The purpose of this study was to determine the biomechanical changes after first dorsal compartment release.

In this article, a kinetic model is introduced in conjunction with experimental extrusion results to predict the evolution of depolymerization reaction at various operating conditions during ultra-high speed twin screw extrusion (TSE). A commercially available flow simulation software (LUDOVIC®) was used to calculate thermomechanical flow parameters for various screw profiles. The simulated local material temperature and mechanical shear rate were used as inputs to develop a kinetic model that separately describes the effects of temperature and shear on the extent of degradation reaction due to extruding at very high speeds. The model is validated through comparison with experimental gel permeation chromatography (GPC) results on extruded samples. A good agreement was found between theoretical and experimental results. This validation makes the model practically useful for processing optimization, which is a considerable challenge for realizing compounding benefits in ultra-high speed TSE.

Acrylonitrile butadiene styrene (ABS) nanocomposites containing Cloisite 11 organoclay at 2 wt% were prepared using a 60 L/D ultra- high speed twin screw extruder (TSE), with speeds ranging from 400 to 4000 rpm. The purpose of this study was to investigate the effect of high shear melt processing on the intercalation and exfoliation of organoclay in the polymer, as well as the mechanical and rheological properties of the material. X-ray Diffraction (XRD), and Transmission Electron Microscopy (TEM) results showed better intercalation of the nanofiller with increasing screw speed up to a point, and indicated an exfoliated structure of the nanocomposites extruded at 4000 rpm. Mechanical and rheological testing results indicated that by adding organoclay to ABS, the properties improved with increasing screw speed up to an optimum value of 2000 rpm. However, at the higher screw speeds of 3000 and 4000 rpm, the intense shear history led to a decrease in properties, most likely due to chain scission and molecular weight reduction. Similar trends were observed in rheological properties of the nanocomposite as well. At 2000 rpm, the results indicate that the lowering of the molecular weight due to shear effects is balanced by good intercalation/exfoliation of the organoclay. POLYM. ENG. SCI., 57:60–68, 2017. © 2016 Society of Plastics Engineers

This article characterizes a novel twin screw extrusion (TSE) process with the capability of rotating at speeds up to 4500 rpm. The resulting extreme high shear rate is expected to result in molecular weight changes due to thermomechanical degradation of the polymeric materials being extruded, polystyrene (PS) in this case. In order to differentiate between mechanical and thermal factors affecting degradation of PS running at ultrahigh speeds and also to evaluate the relative importance of the two mechanisms, PS has been extruded at different screw speeds and different barrel temperatures with corresponding melt temperatures. Viscosity measurements and size exclusion chromatography measurements show the extent of degradation due to mechanical stress as a result of high screw rotational speeds. Furthermore, through analyzing the kinetics of PS depolymerization, the reaction rate and hypothetical apparent temperatures at each screw speed have been calculated. All results support the idea that the mechanical shear stress can be considered as the controlling factor of polymer degradation in ultrahigh speed TSE. POLYM. ENG. SCI., 2016. © 2016 Society of Plastics Engineers

Osteochondral lesions of the ankle joint are one of the common disorders, especially after ankle joint injury. This study reports the results of studes that evaluated the mosaicplasty procedure for osteochondral lesions of the ankle joint. This review included all articles published during 2000 to 2018 and search was performed in databases of Science Direct, Google Scholar, PubMed and ISI Web of Knowledge using OR, AND, NOT between the selected keywords. The results of this review article showed that mosaicplasty can reduce pain and increase function in patients with Osteochondral lesions of the ankle joint and so it can be a good treatment option.

Introduction & Objective: Percutaneous Dilatational Tratheostomy (PDT) is an elective procedure increasingly performed at bedside in intensive care unit (ICU). With this technique the complications during transferring to the operating room, duration between one patient candidate for PDT to perform it and cost decreased compared to the standard technique. In our study we compared the duration and complications of tracheostomy in percutaneous tracheostomy with surgical tracheostomy. Materials & Methods: In this clinical trial 18 patients candidating PDT underwent PDT with Griggs method in the ICU (Group 1) and simultaneously compared with 18 patients that underwent surgical tracheostomy (group 2). Results: The two groups based on characteristics such as age, sex, hemodynamic variables (systolic blood pressure, diastolic blood pressure, heart rate) , pulmonary function ,and oxygenation measured by pulse oximetry were similar. The duration of stay in ICU was also similar between the two groups. Mean delay time among the candidates to perform tracheostomy in group 1 was 1.38±0.6 (1-3) days and in group 2 was 4.55±2.33 (2-10) days respectively, (p

The problem of a planar slider-crank mechanism with clearance at the sliding (prismatic) joint is investigated. In this study the influence of the clearance gap size, bearing friction, crank speed and impact parameters on the response of the system are investigated. Three types of responses are observed: chaotic, transient chaos and periodic. It is shown that chaotic motion is prevalent over a range of parameters which corresponds to high crank speeds and/or low values of bearing friction with relatively ideal impacts. Periodic response is generally observed at low crank speeds and also at low values of the coefficient of restitution. Poincare maps and statistical profiles of the impact locations and severity are used to characterize the motion and to obtain information regarding possible patterns of wear due to repeated impacts. As expected, chaotic motions lead to quite uniform distributions of impacts, while periodic motions lead to highly localized impact locations. It is also shown that the system response is essentially unpredictable over a wide range of parameters, thus casting doubt on the usefulness of such models for accurate prediction purposes.

Background: The mechanism of action of sweet substance-induced analgesia is thought to involve activation of the endogenous opioid system. The nitric oxide (NO) pathway has a pivotal role in pain modulation of analgesic compounds such as opioids. Objectives: We investigated the role of NO and the opioid receptor-mediated system in the analgesic effect of sucrose ingestion in mice. Materials and Methods: We evaluated the effect of intraperitoneal administration of 10 mg/kg of NO synthase inhibitor, N-nitro-L-arginine methyl ester (L-NAME) and 20 mg/kg of opioid receptor antagonist, naltrexone on the tail flick response in sucrose ingesting mice. Results: Sucrose ingestion for 12 days induced a statistically significant increase in the latency of tail flick response which was unmodified by L-NAME, but partially inhibited by naltrexone administration. Conclusions: Sucrose-induced nociception may be explained by facilitating the release of endogenous opioid peptides. Contrary to some previously studied pain models, the NO/cyclic guanosine monophosphate (cGMP) pathway had no role in thermal hyperalgesia in our study. We recommend further studies on the involvement of NO in other animals and pain models.