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The optimal surgical excision margins are uncertain for patients with thick (>2 mm) localised cutaneous melanomas. In our previous report of this multicentre, randomised controlled trial, with a median follow-up of 6·7 years, we showed that a narrow excision margin (2 cm vs 4 cm) did not affect melanoma-specific nor overall survival. Here, we present extended follow-up of this cohort. In this open-label, multicentre randomised controlled trial, we recruited patients from 53 hospitals in Sweden, Denmark, Estonia, and Norway. We enrolled clinically staged patients aged 75 years or younger diagnosed with localised cutaneous melanoma thicker than 2 mm, and with primary site on the trunk or upper or lower extremities. Patients were randomly allocated (1:1) to treatment either with a 2-cm or a 4-cm excision margin. A physician enrolled the patients after histological confirmation of a cutaneous melanoma thicker than 2 mm. Some patients were enrolled by a physician acting as responsible for clinical care and as a trial investigator (follow-up, data collection, and manuscript writing). In other cases physicians not involved in running the trial enrolled patients. Randomisation was done by telephone call to a randomisation office, by sealed envelope, or by computer generated lists using permuted blocks. Patients were stratified according to geographical region. No part of the trial was masked. The primary outcome in this extended follow-up study was overall survival and the co-primary outcome was melanoma-specific survival. All analyses were done on an intention-to-treat basis. The study is registered with ClinicalTrials.gov, number NCT03638492. Between Jan 22, 1992, and May 19, 2004, 936 clinically staged patients were recruited and randomly assigned to a 4-cm excision margin (n=465) or a 2-cm excision margin (n=471). At a median overall follow-up of 19·6 years (235 months, IQR 200–260), 621 deaths were reported—304 (49%) in the 2-cm group and 317 (51%) in the 4-cm group (unadjusted HR 0·98, 95% CI 0·83–1·14; p=0·75). 397 deaths were attributed to cutaneous melanoma—192 (48%) in the 2-cm excision margin group and 205 (52%) in the 4-cm excision margin group (unadjusted HR 0·95, 95% CI 0·78–1·16, p=0·61). A 2-cm excision margin was safe for patients with thick (>2 mm) localised cutaneous melanoma at a follow-up of median 19·6 years. These findings support the use of 2-cm excision margins in current clinical practice. The Swedish Cancer Society, Stockholm Cancer Society, the Swedish Society for Medical Research, Radiumhemmet Research funds, Stockholm County Council, Wallström funds.

Increased frontal-plane knee motion during functional tasks, or medial knee displacement, is a predictor of noncontact anterior cruciate ligament injury and patellofemoral pain. Intervention studies that resulted in a reduced risk of knee injury included some form of feedback to address aberrant lower extremity movement patterns. Research on integrating feedback into single-legged tasks and the ability to train 1 task and test another is limited. To determine if adding real-time visual biofeedback to common lower extremity exercises would improve single-legged landing mechanics in females with medial knee displacement. Cohort study. University laboratory. Twenty-four recreationally active females with medial knee displacement were randomized to a visual-biofeedback group (n = 12; age = 19.75 ± 0.87 years, height = 165.32 ± 8.69 cm, mass = 62.41 ± 8.91 kg) or a control group (n = 12; age = 19.75 ± 0.97 years, height = 166.98 ± 6.89 cm, mass = 59.98 ± 6.24 kg). Individuals in the feedback group viewed a real-time digital model of their body segments generated by Microsoft Kinect. The skeletal model changed color according to the knee-abduction angle of the test limb during the exercise tasks. Participants completed 3 trials of the single-legged drop vertical jump (SL-DVJ) while triplanar kinematics at the trunk, hip, knee, and ankle were collected via 3-dimensional motion capture. The feedback and control groups completed lower extremity exercises with or without real-time visual biofeedback, respectively. After the intervention, participants completed 3 additional trials of the SL-DVJ. At baseline, the feedback group had 3.83° more ankle eversion than the control group after initial contact. After the intervention, the feedback group exhibited 13.03° more knee flexion during the flight phase of the SL-DVJ and 6.16° less knee abduction after initial contact than the control group. The feedback group also demonstrated a 3.02° decrease in peak knee-abduction excursion compared with the baseline values ( = .008). Real-time visual biofeedback immediately improved faulty lower extremity kinematics related to knee-injury risk. Individuals with medial knee displacement adjusted their movement patterns after a single training session and reduced their medial knee motion during a dynamic task.

Comprehensive injury-prevention training (plyometric, agility, balance, and core-stability exercises) has been shown to decrease sport-related injury. The relationship between trunk control and sport-related injury has been emphasized; however, the isolated effects of core-muscle training are unclear. To investigate the effect of a simple 8-week core-muscle-training program on the neuromuscular control of the lower limb and trunk during jump landing and single-legged squatting. Controlled laboratory study. Laboratory. Seventeen female collegiate basketball players were randomly divided into training (n = 9; age = 19.7 ± 0.9 years) and control (n = 8; age = 20.3 ± 2.5 years) groups. The training group completed the core-muscle-training program in addition to daily practice, and the control group performed only daily practice. Kinematic and kinetic data during a drop-jump test and single-legged squat were acquired using a 3-dimensional motion-analysis system. Three-dimensional hip, knee, and trunk kinematics; knee kinetics; and isokinetic muscle strength were measured at the pretraining and posttraining phases. For the drop-jump test, the maximal trunk-flexion angle increased ( = .008), and peak knee-valgus moment ( = .008) decreased in the training group. For the single-legged squat, the peak trunk-flexion angle increased ( = .04), and the total amount of trunk lateral-inclination angle ( = .02) and peak knee-valgus moment ( = .008) decreased in the training group. We observed no changes in the control group. A consecutive 8-week core-muscle-training program improved lower limb and trunk biomechanics. These altered biomechanical patterns could be favorable to preventing sport-related injuries.

Background and Objectives: Compared to other subjects, obese people have inferior trunk muscle endurance and balance. A modern method of neuro-muscular training called whole body vibration (WBV) may improve trunk muscle endurance and balance. This study evaluates the impact of a 4-week WBV program on trunk endurance and balance in obese female students. Materials and Methods: Sixty participants from 18 to 25 years of age and with BMI values ≥ 30 were randomly distributed into two equal groups: Group A (WBV group), who received 4 min of WBV, and Group B (sham WBV group), who received WBV with a turn-off device. The training was conducted two days/week for six weeks. Trunk endurance was evaluated using the Sorensen Test (ST) and Trunk Flexor Endurance Test (TFET). The Single-Leg Test (SLT) was used to assess static balance, while the Biodex Stability System measured dynamic balance. Results: The current study demonstrated no significant differences (p > 0.05) in pre-treatment variables between Groups A and B. Post-treatment, Group A showed a significantly higher duration of the Sorensen test, TFET and SLS than Group B (p < 0.001). Moreover, Group A showed significantly lower dynamic balance (p < 0.001) than Group B. Conclusions: WBV has a short-term effect on trunk endurance and balance in obese female students. WBV can be added to the rehabilitation program for obese subjects with deficits in trunk endurance and balance.

Patrocinado por: Ministerio de Economía y Competitividad y Fondo Europeo de Desarrollo Regional (FEDER). Proyecto TIN2012-37546-C03-01 (Destinataria: Ana Ferrer Albero) Ministerio de Economía y Competitividad y Fondo Europeo de Desarrollo Regional (FEDER). Proyecto TIN2014-59932-jin (Destinatario: Rafael Sebastián Aguilar) Generalitat Valenciana. Programa Prometeo. (Destinatario: Laura Martínez Mateu).

Bridges and bird-dog exercises are commonly used in general training, as well as in warm-up and cool-down routines for young athletes to boost performance and prevent injuries. They are frequently paired with limb and other trunk exercises, and performed without precise control over intensity, which hinders the understanding of their actual impact. This double-blinded randomized controlled trial aimed to evaluate the effects of two bridging and bird-dog exercise programs (one emphasizing intensity, the other volume) on trunk performance and whole-body balance. Sixty participants were randomly assigned to a control group and two experimental groups, both of which performed bridging and bird-dog exercises at a specific intensity controlled by a smartphone-accelerometer. The exercises were conducted twice a week for six weeks at the university sports complex. The effects were assessed on: (i) trunk stability, through the bridging and the bird-dog lumbopelvic postural control, the unstable sitting and the sudden loading sitting tests, (ii) trunk endurance, through the front and the dominant side bridge endurance, and the Biering-Sorensen tests, and (iii) whole-body dynamic balance, through the Y-Balance, the tandem and single-leg stance, and the single-leg triple hop tests. Pre-post changes were reported in both absolute (Δ) and relative (Δ%) values. A two-way mixed ANOVA assessed differences between experimental and control groups, while paired t-tests analyzed within-group pre-post changes with a significance level set at p  < 0.05. Neither of the experimental groups showed improvements in trunk performance and balance compared to the control group or among themselves. Nonetheless, the higher intensity group elicited greater pre-post changes in the bridging and the bird-dog lumbopelvic postural control tests (−10.4 ≤Δ% ≤−16.9 vs −4.8 ≤Δ% ≤−13.6), whilst the higher volume group did in the trunk endurance tests (10.9 ≤Δ% ≤19.5 vs 7.1 ≤Δ% ≤15.5). The lack of significant between-group differences may be due to the low exercise doses, typical for these exercises in fitness and rehabilitation routines, and the participants being active young males with no apparent postural control deficits. Additionally, the pre-post changes in the experimental groups highlight the specificity of exercise adaptations. This study questions the effectiveness of bridging and bird-dog exercises for improving trunk performance and whole-body balance in this population, beyond the tasks used in training.

Three-dimensional surface topography offers a noninvasive alternative to radiographic imaging for evaluating trunk morphology and posture. This study aimed to establish normative values of trunk cross-sectional geometry and to examine their associations with spinal alignment in healthy young adults. A cross-sectional sample of 108 participants (62 women, 46 men; 19–23 years, normal BMI) underwent assessment using two complementary techniques: TorsoScan, which reconstructed 360° trunk cross-sections at thoracic levels T1, T4, T8, and T12, and DIERS Formetric 4D, which quantified spinal posture parameters. For each cross-section, sagittal and coronal diameters and cross-sectional areas were calculated; sex differences were analyzed using Welch’s t tests and effect sizes, and associations with posture were examined by Pearson correlations with false discovery rate correction and regression modeling. Trunk geometry followed a regular thoracic profile, with the largest coronal diameter at T4 and the maximal area at T8. Men showed consistently larger diameters and areas than women, with large effect sizes at T4–T12. Four associations remained significant: reduced mid-thoracic breadth and area were linked to greater lumbar lordosis, while upper thoracic depth correlated positively with thoracic kyphosis. Predictive models based on posture explained limited variance (R2 ≤ 0.19). These findings provide sex-specific reference values and demonstrate that TorsoScan and DIERS Formetric yield complementary, partly convergent measures that may support radiation-free evaluation of trunk morphology in clinical and rehabilitative settings.

To explore secondary outcomes at endpoint comparing treatments with adequate self-mediated physical activity combined with either night-time brace (NB), scoliosis-specific exercise (SSE), or adequate self-mediated physical activity alone (PA) in Adolescent Idiopathic Scoliosis (AIS). A longitudinal, prospective, multicenter RCT was conducted including 135 girls/boys, Cobb angle 25-40°, 9-17 years, and ≥1-year remaining growth were randomly allocated into NB, SSE, or PA group. Endpoint was curve progression of ≤6° (success) at skeletal maturity or >6° (failure). Outcomes included angle of trunk rotation (ATR), major curve Cobb angle, Spinal Appearance Questionnaire (pSAQ), Scoliosis Research Society-22r (SRS-22r), EQ-5Dimensions Youth 3Levels (EQ-5D-Y-3L), and EQ-Visual-Analogue-Scale (EQ-VAS), adherence to treatment and International Physical Activity Questionnaire (IPAQ-SF). At endpoint, 122 patients were analyzed per protocol, mean age 12.7 (±1.4) years, and mean Cobb angle 31° (±4.3). A significant difference in change for ATR favored NB group compared to SSE group -2.0º (95% CI -3.7 to -0.3). EQ-5D-Y-3L dimensions showed a significant difference in change with decrease in mobility (p=0.031), and usual activities (p=0.003) for SSE compared to NB and PA groups. Treatment adherence was adequate but slightly better in NB and PA groups compared to SSE on self-report (p=0.012), and health care provider (HCP) report was better in PA compared to SSE group (p=0.013). Higher motivation and capability explained 53% of the variability and gave better odds for higher adherence (OR = 11.12, 95% CI = 1.5 to 34.4; OR = 7.23, 95% CI = 2.9 to 43.3), respectively. Night-time brace, scoliosis-specific exercise or physical activity interventions for adolescents with idiopathic scoliosis showed small differences between groups in trunk rotation, spinal deformity and appearance, health-related quality of life, and treatment adherence but not likely reaching clinical relevance.

Efficient shoulder movement depends on the ability of central nervous system to integrate sensory information and to create an appropriate motor command. Various daily encountered factors can potentially compromise the execution of the command, such as fatigue. This study explored how fatigue influences shoulder movements during upper limb reaching. Forty healthy participants were randomly assigned to one of two groups: Control or Fatigue Group. All participants completed an upper limb reaching task at baseline and post-experimental, during which they reached four targets located at 90° of shoulder abduction, 90° external rotation at 90° abduction, 120° scaption, and 120° flexion in a virtual reality environment. Following the baseline phase, the Fatigue Group completed a shoulder fatigue protocol, while Controls took a 10-minute break. Thereafter, the reaching task was repeated. Upper limb kinematic (joint angles and excursions) and spatiotemporal (speed and accuracy) data were collected during the reaching task. Electromyographic activity of the anterior and middle deltoids were also collected to characterize fatigue. Two-way repeated-measures ANOVA were performed to determine the effects of Time, Group and of the interaction between these factors. The Fatigue group showed decreased mean median power frequency and increased electromyographic amplitudes of the anterior deltoid (p < 0.05) following the fatigue protocol. Less glenohumeral elevation, increased trunk flexion and rotation and sternoclavicular elevation were also observed in the Fatigue group (Group x Time interaction, p < 0.05). The Control group improved their movement speed and accuracy in post-experimental phase, while the Fatigue group showed a decrease of movement speed and no accuracy improvement (Group x Time interaction, p < 0.05). In a fatigued state, changes in movement strategy were observed during the reaching task, including increased trunk and sternoclavicular movements and less glenohumeral movement. Performance was altered as shown by the lack of accuracy improvement over time and a decrease in movement speed in the Fatigue group.

We explored in 75 s long trials the effects of visually induced self-rotation and displacement (SR&D) on the horizontally extended right arm of standing subjects (N = 12). A “tool condition” was included in which subjects held a long rod. The extent of arm movement was contingent on whether the arm was extended out Freely or Pointing at a briefly proprioceptively specified target position. The results were nearly identical when subjects held the rod. Subjects in the Free conditions showed significant unintentional arm deviations, averaging 55° in the direction opposite the induced illusory self-motion. Deviations in the Pointing conditions were on average a fifth of those in the Free condition. Deviations of head and torso positions also occurred in all conditions. Total arm and head deviations were the sum of deviations of the arm and head with respect to the torso and deviations of the torso with respect to space. Pointing subjects were able to detect and correct for arm and head deviations with respect to the torso but not for the arm and head deviations with respect to space due to deviations of the torso. In all conditions, arm, head, and torso deviations began before subjects experienced SR&D. We relate our findings to being an extension of the manual following response (MFR) mechanism to influence passive arm control and arm target maintenance as well. Visual-vestibular convergence at vestibular nuclei cells and multiple cortical movement related areas can explain our results, MFR results, and classical Pass Pointing. We distinguish two Phases in the induction of SR&D. In Phase 1, the visual stimulation period prior to SR&D onset, the arm, head, and torso deviations are first apparent, circa < 1 s after stimulus begins. They are augmented at the onset of Phase 2 that starts when SR&D is first sensed. In Phase 2, reaching movements first show curved paths that are compensatory for the Coriolis forces that would be generated on the reaching arm were subjects actually physically rotating. These movement deviations are in the opposite direction to the MFR and the arm, head, and torso deviations reported here. Our results have implications for vehicle control in environments that can induce illusory self motion and displacement.