Clermont Ferrand Cã©dex 1, France

Comparison of Symptoms, Pulmonary Function, Muscle Strength, Exercise Capacity, and Frailty Level in Individuals With Esophageal Atresia and Healthy Individuals

Can Lumbar Mulligan Mobilization Improve Gait, Balance, and Trunk Position Sense After Stroke?

Stroke is a high-morbidity condition caused by a disruption in the brain's arterial circulation, resulting in various neurological impairments, including motor, sensory, and cognitive deficits. These impairments lead to a decrease in the individual's ability to perform daily activities independently, as muscle strength, postural control, sensation, and gait are negatively affected. Stroke patients often face an increased risk of falls due to balance deficits, which can also contribute to a significant fear of falling. Thus, improving balance control is an essential therapeutic goal in stroke rehabilitation. The trunk plays a pivotal role in balance control, and it should be the primary focus in rehabilitation programs. In individuals with restricted lumbar mobility, weakened trunk muscles or altered muscle activation patterns lead to decreased lumbar proprioception, impaired hip strategy, and reduced spinal stabilization, all of which contribute to balance difficulties. Recent studies suggest that combining conventional rehabilitation techniques with other interventions can provide more effective results. In stroke rehabilitation, different mobilization techniques are increasingly being used. One such approach is the Mulligan Concept, which is commonly applied in musculoskeletal disorders, particularly in the treatment of knee, ankle, and shoulder problems in stroke patients. However, there has been limited research on the effectiveness of Mulligan-based lumbar spine mobilization in stroke patients. The Mulligan technique, particularly the Sustained Natural Apophyseal Glides (SNAG) technique, may help improve the individual's ability to move the body freely and enhance mobility and function, ultimately increasing confidence and reducing psychological barriers such as the fear of movement. This study aims to evaluate the effectiveness of Mulligan-based lumbar mobilization in enhancing balance, trunk position sense, and gait in individuals with stroke. By assessing the impacts of this technique, the study seeks to contribute to the development of more effective rehabilitation strategies that can improve functional outcomes and quality of life for stroke patients.

Transversalis Fascia Plane vs Ilioinguinal and Iliohypogastric Nerve Block for the Treatment of CPIP

Chronic post-herniorrhaphy inguinal pain (CPIP) after inguinal hernia surgery significantly affects quality of life and daily activities. The incidence of this condition ranges from 15% to 53% and its management is often challenging. CPIP is defined as pain lasting more than three months and can be diagnosed if no organic cause can be found to explain the pain at the end of this period. There are various methods in the treatment of CPIP, including medical therapy, nerve blocks and surgical intervention. The inguinal region is mainly innervated by the ilioinguinal (II) and iliohypogastric (IH) nerves. These nerves are the most commonly damaged structures after inguinal hernia surgery. However, the II and IH nerves can be easily blocked in isolation throughout their entire course in the groin area or in the abdominal wall at different injection sites using fascial plane blocks such as transversalis fascia plan block (TFP). These blocks are frequently preferred because of their ease of application and wide analgesic effects. Therefore, studies investigating the efficacy of fascial blocks that provide ease of application are increasing. Although TFP and II-IH blocks have been used in the treatment of acute postoperative inguinal pain, they have been used in a limited number of studies for CPIP; however, no study has compared the efficacy and advers effect rates of these methods. The primary aim of this study is to compare the efficacy of these two treatment modalities. The secondary aim is to determine the incidence of adverse events associated with US-guided TFP and II-IH nerve block therapy. A total of at least 80 patients will be enrolled for comparison, 40 patients in each group. The NRS score will be compared both within and between groups before, 1 month after and 3 months after treatment.

Sleep Characteristics in Late Premature Infants

Late preterm infants are defined as those born between 34 and 36 weeks and 6 days of gestational age. Although the medical literature places significant emphasis on extremely low birth weight and extremely preterm infants, late preterm infants are also at risk, with mortality rates three times higher than those of term infants. Born with lungs and brains that are not yet fully matured, late preterm infants may experience complications due to immaturity. Although they often appear healthier and more mature than they are, late preterm infants show significant differences from term infants (born between 37 and 42 weeks of gestation), particularly because their brain development has not yet been completed. During the final weeks of gestation (34-40 weeks), critical developmental processes occur in the brain, including the formation of synaptic connections, myelination, and the development of cortical folds. Compared to normal term neonates, the late preterm brain appears 20% to 30% smaller, less developed, and less myelinated on magnetic resonance imaging. The sensory system is shaped immediately after birth by both the quantity and type of sensory experiences and continues to develop throughout life. In preterm infants, sensory processing has been associated with immaturity at birth, length of stay in the neonatal intensive care unit, white matter injury, and caregiver education. Sleep is a critical factor for the healthy development of processes such as brain maturation, motor planning, postural control, and sensory integration, especially during infancy. Sleep is closely linked to brain development and infant behavior, and disruptions in sleep patterns can have profound and long-term effects on an infant's overall health, growth, and well-being in early life. Moreover, sleep plays a crucial role in the formation of persistent neural circuits necessary for early sensory development and the maturation of primary sensory systems in infants. The aim of this study is to investigate the relationship between sleep characteristics and motor development and sensory processing skills in late preterm infants (born between 34 weeks and 36 weeks + 6 days of gestation) who are between 6 and 12 months of corrected age. It is thought that sleep problems, which are frequently observed in preterm infants, may have significant effects on motor and sensory development. In this context, the primary objective of the study is to elucidate how sleep patterns and characteristics are associated with motor and sensory development in late preterm infants, and to provide scientific evidence to inform early intervention programs.

Development in Children Diagnosed with Congenital Muscular Torticollis

Congenital muscular torticollis (CMT) is a common postural deformity that occurs shortly after birth and is typically characterized by ipsilateral cervical lateral flexion and contralateral cervical rotation due to unilateral shortening of the sternocleidomastoid (SCM) muscle. It is a non-neurological postural disorder that usually affects 3% to 16% of infants. Theories such as intrauterine stenosis, vascular causes, fibrosis of the peripartum hemorrhage area, difficult labor, and primary myopathy of the SCM muscle have been put forward for its causes. In tissue samples taken after surgery, edema, degeneration of muscle fibers, and fibrosis have been reported. It is thought that CMT affects the muscles as well as head and facial development, causing various asymmetries, delays in gross motor functions, and disorders in posture and balance control. A bent neck position can cause plagiocephaly. Characteristic craniofacial deformities include asymmetry in the brow and cheekbones, deviation of the chin and nose tip, inferior orbital abnormality on the affected side, asymmetry in ear placement, and shortening of the vertical dimension of the ipsilateral face. In later periods, it has been shown that it may cause asymmetry in the use of the upper extremities, delay in gross motor functions, and effects on posture and balance control in children. It is thought that head position may affect the shoulder, rib cage, and abdominal muscles, which may have a negative effect on posture control and movement development, sensory-motor coordination, and cause gross motor function retardation. For these reasons, children with congenital muscular torticollis should be evaluated comprehensively in the early period. This study, which was planned to evaluate the motor development and sensory processing of children with CMT, was designed according to the lack of literature.

Management of Dysuria and Irritative Symptoms After HoLEP: a Prospective Study Evaluating the Efficacy of Alpha-Blocker Therapy

The Effects of Anesthesia Depth Monitoring on Postoperative Recovery and Cognitive Functions in the Geriatric Patient Population

Perioperative cognitive decline and delirium occur more frequently in the geriatric population undergoing surgery. International guidelines recommend monitoring anesthesia depth to reduce the risk of postoperative cognitive dysfunction. Anesthesia depth is commonly measured using non-invasive electroencephalography (EEG)-based methods, such as the Bispectral Index (BIS). Previous studies have predominantly utilized processed EEG monitors that generate numerical values for tracking anesthesia depth. However, in this study, anesthesia depth will be monitored using both the standard numerical BIS index and the Density Spectral Array (DSA) mode, an advanced feature of the BIS device. To date, no studies have simultaneously examined BIS and DSA modes in relation to cognitive function and the recovery process. The use of advanced monitoring techniques may serve as a valuable resource for future research, particularly in optimizing anesthetic management for geriatric patients with reduced cognitive reserve. This study aims to evaluate the effects of different intraoperative anesthesia depth monitoring approaches, including hemodynamic monitoring, numerical BIS values, and DSA functions. The primary objective is to determine the optimal anesthesia monitoring strategy that minimizes intraoperative hypotension, burst suppression, and postoperative delirium.

Comparison of Postoperative Analgesic Efficacy of Suprainguinal Fascia Iliaca Block and Pericapsular Nerve Group Block with Lateral Femoral Cutaneous Nerve Block in Patients Undergoing Total Hip Arthroplasty

48 patients undergoing THA under general anesthesia who received either SFIB or PENG block with LFCN block using will be included in the study. Postoperative static and dynamic VAS scores, opioid consumption, quadriceps motor strength, ability to perform physiotherapy and presence of opioid or nerve block related complications will be recorded.

Effects of Wheelchair Treadmill and Conventional Exercises on Trunk Balance in Spinal Cord Injury Patients

Our study is a prospective observational study. Regardless of whether the exercises are performed conventionally or using an alternative platform such as a wheelchair treadmill, all interventions included in the study are routine clinical practices. Patients whose treatment programs already adhere to the aforementioned procedures will be included in the study. In the Upper Extremity and Hand Rehabilitation Laboratory, where the wheelchair treadmill is available, patients with spinal cord injuries undergo a standardized rehabilitation program as part of routine clinical practice. This laboratory operates on a scheduled appointment basis. After random allocation into groups, patients in the experimental group will be assessed at the beginning and end of the wheelchair treadmill therapy. Meanwhile, patients in the control group will be enrolled in the study before initiating wheelchair treadmill therapy. Once the data from the control group have been collected, these patients will also have the opportunity to receive wheelchair treadmill therapy. The wheelchair treadmill to be utilized in the study is the h/p/cosmos saturn® 300/100 r model. The device includes two separate safety belts for the participant and the wheelchair, along with a wheelchair stabilizer equipped with three different locking mechanisms. Additionally, three emergency stop buttons located in different areas ensure maximum patient safety. Treadmill exercises will be conducted at a submaximal level with a 0.7% incline. Heart rate will be monitored using a portable device. Regardless of whether the exercises are performed conventionally or on a treadmill, all exercises are part of routine clinical practice. Patients already receiving treatment in accordance with the aforementioned procedure will be included in the study. Participants will be randomly assigned to groups. Data Quality and Management Procedures Patients admitted for inpatient treatment at the Spinal Cord Injury Rehabilitation Clinic of Ankara Bilkent City Hospital, who meet the inclusion criteria and voluntarily agree to participate in the study by reading and signing the informed consent form, will be included in the study. The medical status of all participants will be evaluated and recorded by the clinical research responsible physician. Exercise interventions will be carried out by two experienced physiotherapists working at the hospital. The patients' data will also be collected by these two physiotherapists. Volunteers will be assessed at Ankara City Hospital Physical Therapy and Rehabilitation Hospital, within the Spinal Cord Injury Rehabilitation Neurophysiological Exercise Laboratory and the Upper Extremity and Hand Rehabilitation Laboratory, utilizing the treadmill available in the facility's sports hall. A predefined data management plan will be implemented for missing, inconsistent, or erroneous data. Missing data will be identified and analyzed using statistical methods such as multiple imputation when necessary. To ensure the integrity of data entry, regular audits and consistency checks will be performed by another physiotherapist involved in the study. To increase the reliability of the data, patient records and assessment reports will be cross-checked with the collected data. This will include comparisons made with electronic health records, paper-based case reports, and direct observation notes. All study procedures, including patient recruitment, data collection, data entry, data analysis, and reporting of adverse events, will be carried out according to predefined criteria. Any adverse events or unexpected complications occurring during the study will be systematically documented and reported. To determine the appropriate sample size, 10 patients per group will be included. Based on the obtained pilot data, a power analysis will be conducted using the G* Power program (version 3.0.10, Universität Düsseldorf, Düsseldorf, Germany). For statistical analysis, descriptive statistics will be presented as the mean and standard deviation for numerical variables if the parametric assumptions are met, and as the median and minimum-maximum values if the parametric assumptions are not met. For categorical variables, frequency and percentage values will be reported. The statistical significance of differences between groups will be examined using the Independent Samples T-Test if parametric assumptions are met, and the Mann-Whitney U Test if parametric assumptions are not met. Analyses will be conducted with a significance level of p < 0.05.

Investigating the Relationship Between Temporal Bone CT, Bone Density, and Hearing Loss in Otosclerosis Patients