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To investigate the influence of task, limb dominance and previous injury on single leg hop task performance and loading response, 25 professional male soccer players completed anterior, medial and lateral hop tests with an accelerometer at mid-calf. Performance outcome was defined as hop distance with loading response defined as the magnitude of, and time to peak instantaneous planar PlayerLoad. The performance was sensitive to task and previous injury (P < 0.001) but not limb dominance, with no evidence of bilateral asymmetry (P = 0.668). Despite impaired performance, previously injured players did not exhibit lower peak instantaneous PlayerLoad after impact in any plane (P ≥ 0.110). There was however a significantly (P = 0.001) longer time to peak medio-lateral loading after impact in previously injured players' affected limb. This observation was exacerbated when the injury was to the non-dominant limb (P = 0.041). Lower-limb accelerometry enhances understanding of movement strategy beyond task outcome, with practical implications in player screening and objective rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to examine 1) the degree and frequency of laterality in posterior tibial slope (PTS) with control and anterior cruciate ligament (ACL) injury groups and 2) the laterality of PTS between sides of injury and dominant legs in patients with primary ACL injuries. Methods: A total of 187 consecutive patients with clinically diagnosed noncontact ACL injuries and an age- and sex-matched 1:1 control group were identified. PTS was measured using three different methods (aPTS = anterior PTS, mPTS = middle PTS, pPTS = posterior PTS) on a lateral knee radiograph. PTS of the left and right sides were compared between the patients in the control and ACL-injured groups, and between the injured and non-injured and dominant and non-dominant legs among the patients in the ACL-injured group. The patients with a difference in PTS of ≥ 3° in mPTS were selected. The percentages were compared between left and right between and among both groups, and between the injured and non-injured, and non-dominant and dominant leg, for the ACL group. Multiple regression analysis was performed to analyze the factors influencing the degree of mPTS. Results: Both control (Right vs Left: aPTS; 9.0 ± 2.5 vs 10.5 ± 3.0, mPTS; 6.6 ± 2.3 vs 8.1 ± 2.7, pPTS; 4.0 ± 2.4 vs 5.6 ± 2.8, respectively, p < 0.01) and ACL injury groups (Right vs Left: aPTS; 10.6 ± 3.0 vs 12.6 ± 2.9, mPTS; 7.6 ± 2.6 vs 9.5 ± 2.6, pPTS; 5.9 ± 3.0 vs 8.0 ± 3.0, respectively, p < 0.01) had a significantly greater PTS on the left than on the right side, and the ACL group had a significantly greater PTS than the control group on both the left and right sides. In the ACL group, PTS was greater on the injured and the non-dominant leg than on the non-injured and the dominant leg. The percentage of patients with a PTS difference of ≥ 3° was significantly greater on the left, injured, and non-dominant leg (95.3% vs 4.7%, 73.8% vs 26.2%, 86.1% vs 13.9%, respectively, p < 0.01). Only the left leg had a significant influence on PTS in the multivariate analysis. Conclusion: There was laterality in PTS within control and ACL injury groups, and this information is of benefit for effective treatment of ACL injuries. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

We studied the effects of long-term anti-orthostatic hypokinesia (head-down bed rest—BR, a model of gravitational unloading) on the dynamics of orthostasis-induced changes in the content of total (THb), deoxygenated (HHb), and oxygenated (OHb) hemoglobin in the calf at the level of the gastrocnemius muscle medial head using near-infrared spectroscopy. In seven young men, 2–4 days before and on the 19th day of BR, a passive head-up tilt test was performed (15 min in the supine position, then 15 min at 65°). After BR, there was an increase in heart rate and a decrease in stroke volume in the supine position, as well as more pronounced changes in these parameters during orthostasis. Blood pressure in the supine position and orthostasis did not change after BR. THb content increased gradually during orthostasis and reached a plateau by the end of the test; after BR, an increase in the half-rise time and a twofold increase in the plateau level were observed. Tissue HHb content by the end of the tilt test also increased after BR. The dynamics of OHb before BR was more complicated: this indicator grew, reached a maximum during a minute, and then gradually decreased to half of the maximum by the end of the test. After BR, the dynamics of OHb changed drastically: the signal increased gradually and reached a level that was twice the peak value of OHb content before BR. The results allow us to conclude that exposure to BR weakens the compensatory constriction of calf vessels during tilt test; consequently, it is followed by higher blood accumulation in calf vascular bed, which, in turn, leads to smaller SV during orthostasis. [ABSTRACT FROM AUTHOR]

Blood pressure (BP) responses to sodium intake show great variation, discriminating salt-sensitive (SS) from salt-resistant (SR) individuals. The pathophysiology behind salt sensitivity is still not fully elucidated. We aimed to investigate salt-induced effects on body fluid, vascular tone, and autonomic cardiac response with regard to BP change in healthy normotensive individuals. We performed a randomized crossover study in 51 normotensive individuals with normal body mass index and estimated glomerular filtration rate. Subjects followed both a low-Na+ diet (LSD, <50 mmol/day) and a high-Na+ diet (HSD, >200 mmol/day). Cardiac output, systemic vascular resistance (SVR), and cardiac autonomous activity, through heart rate variability and cross-correlation baroreflex sensitivity (xBRS), were assessed with noninvasive continuous finger BP measurements. In a subset, extracellular volume (ECV) was assessed by iohexol measurements. Subjects were characterized as SS if mean arterial pressure (MAP) increased ≥3 mmHg after HSD. After HSD, SS subjects (25%) showed a 6.1-mmHg (SD 1.9) increase in MAP. No differences between SS and SR in body weight, cardiac output, or ECV were found. SVR was positively correlated with Delta BP (r = 0.31, P = 0.03). xBRS and heart rate variability were significantly higher in SS participants compared to SR participants after both HSD and LSD. Sodium loading did not alter heart rate variability within groups. Salt sensitivity in normotensive individuals is associated with an inability to decrease SVR upon high salt intake that is accompanied by alterations in autonomous cardiac regulation, as reflected by decreased xBRS and heart rate variability. No discriminatory changes upon high salt were observed among salt-sensitive individuals in body weight and ECV. NEW & NOTEWORTHY Extracellular fluid expansion in normotensive individuals after salt loading is present in both salt-sensitive and salt-resistant individuals and is not discriminatory to the blood pressure response to sodium loading in a steady-state measurement. In normotensive subjects, the ability to sufficiently vasodilate seems to play a pivotal role in salt sensitivity. In a normotensive cohort, differences in sympathovagal balance are also present in low-salt conditions rather than being affected by salt loading. Whereas treatment and prevention of salt-sensitive blood pressure increase are mostly focused on renal sodium handling and extracellular volume regulation, our study suggests that an inability to adequately vasodilate and altered autonomous cardiac functioning are additional key players in the pathophysiology of salt-sensitive blood pressure increase. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty (TKA) is a successful and highly effective procedure in most patients with tricompartmental knee arthritis. Despite the innovations in surgical techniques due to planning software and technological innovations, patients' dissatisfaction after TKA is still high, at up to 20%. Robotic-assisted surgery (RAS) could be considered as a future option for improving outcomes due to its higher accuracy, precision, and reliability. Robotic systems can be classified as fully active, semi-active, or passive depending on the surgeon's involvement during the procedure, and as imageless or image-based according to the necessity of radiological exams for the pre-operative planning. Three of the most well-known robotic systems for knee surgery are MAKO® (Stryker Ltd., Kalamazoo, MI, USA), NAVIO® (Smith & Nephew, Andover, TX, USA), and ROSA® (Zimmer Inc., Warsaw, IN, USA). These systems show differences in terms of surgeon involvement, the use of CT scans or X-rays for pre-operative planning, the possibility to perform both unicompartmental knee arthroplasty (UKA) and TKA (or even total hip arthroplasty THA), and in the different kinds of knee prosthesis that can be implanted. This article aims to describe the features of the most used robotic systems for knee arthroplasty, to examine their outcomes and analyze their cost-effectiveness, and to evaluate future perspectives. [ABSTRACT FROM AUTHOR]

Purpose: Bio-impedance analysis (BIA) has been widely investigated for hemodynamic monitoring. However, previous works rarely modelled two synchronously pulsatile arteries (representing the radial and ulnar arteries) in the wrist/forearm model. This work aims to clarify and quantify the influences of two pulsatile arteries on BIA. Methods: First, two blood-filled arteries were structured in a 3D wrist segment using the finite element method (FEM). Afterwards, an easy-to-produce two-arteries artificial wrist was fabricated with two components: gelatine-based surrounding tissue phantom and saline blood phantom. A syringe driver was utilised to constrict the arteries, and the impedance signals were measured using a Multi-frequency Impedance Analyser (MFIA). Results: Both simulation and experimental results demonstrated the non-negligible influences of the ulnar artery on the overall BIA, inducing unwanted resistance changes to the acquired signals from the radial artery. The phantom experiments revealed the summation of the individual resistance changes caused by a single pulsatile artery was approximately equal to the measured resistance change caused by two synchronously pulsatile arteries, confirming the measured impedance signal at the wrist contains the pulsatile information from both arteries. Conclusion: This work is the first simulation and phantom investigation into two synchronously pulsatile arteries under BIA in the distal forearm, providing a better insight and understanding in the morphology of measured impedance signals. Future research can accordingly select either a small spacing 4-spot electrode configuration for a single artery sensing or a band electrode configuration for overall pulsatile arteries sensing. A more accurate estimation of blood volume change and pulse wave analysis (PWA) could help to develop cuffless blood pressure measurement (BPM). [ABSTRACT FROM AUTHOR]

Background and Objectives: During tilt testing, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients experience an abnormal reduction in cerebral blood flow (CBF). The relationship between this CBF reduction and symptom severity has not been examined in detail. Our hypothesis was that ME/CFS severity is related to the degree of the CBF reduction during tilt testing. Materials and Methods: First, from our database, we selected ME/CFS patients who had undergone assessments of ME/CFS symptomatology and tilt tests on the same day, one at the first visit and the second during a follow-up. The change in symptomatology was related to the change in CBF during the tilt test. Second, we combined the data of two previously published studies (n = 219), where disease severity as defined by the 2011 international consensus criteria (ICC) was available but not published. Results: 71 patients were retested because of worsening symptoms. The ICC disease severity distribution (mild-moderate-severe) changed from 51/45/4% at visit-1 to 1/72/27% at follow-up (p < 0.0001). The %CBF reduction changed from initially 19% to 31% at follow-up (p < 0.0001). Of 39 patients with stable disease, the severity distribution was similar at visit-1 (36/51/13%) and at follow-up (33/49/18%), p = ns. The %CBF reduction remained unchanged: both 24%, p = ns. The combined data of the two previously published studies showed that patients with mild, moderate, and severe disease had %CBF reductions of 25, 29, and 33%, respectively (p < 0.0001). Conclusions: Disease severity and %CBF reduction during tilt testing are highly associated in ME/CFS: a more severe disease is related to a larger %CBF reduction. The data suggest a causal relationship where a larger CBF reduction leads to worsening symptoms. [ABSTRACT FROM AUTHOR]

The purpose of this study was to directly compare implant placement accuracy and postoperative limb alignment between robotic-assisted total knee arthroplasty and navigation-assisted total knee arthroplasty. This retrospective case–control study included a consecutive series of 182 knees (robotic-assisted group, n = 103 knees; navigation-assisted group, n = 79). An image-free handheld robotic system (NAVIO) or an image-free navigation system (Precision N) was used. Component and limb alignment were evaluated on three-dimensional computed tomography scans and full-length standing anterior–posterior radiographs. We compared the errors between the final intraoperative plan and the postoperative coronal and sagittal alignment of the components and the hip–knee–ankle angle between the two groups. The orientation of the femoral and tibial components in the coronal plane were more accurate in the robotic-assisted group than in the navigation-assisted group (p < 0.05). There was no significant difference in the orientation of the femoral and tibial component in the sagittal plane between the two groups. There were fewer outliers in the tibial coronal plane in the robotic-assisted group (p < 0.05). There was also no significant difference in the frequency of outlying values for coronal or sagittal alignment of the femoral component or sagittal alignment of the tibial component or the hip–knee–ankle angle between the two groups. Robotic-assisted total knee arthroplasty using a handheld image-free system improved component alignment in the coronal plane compared with total knee arthroplasty using an image-free navigation system. Robotic surgery helps surgeons to achieve personalised alignment that may result in better clinical outcomes. [ABSTRACT FROM AUTHOR]

The introduction of robotics in orthopedic surgery has led to improved precision and standardization in total knee arthroplasty (TKA). Clinical benefits of robotic versus manual TKA have been well established; however, evidence for economic and healthcare resource utilization outcomes (HRU) is lacking. The primary objective of this study was to compare economic and HRU outcomes for robotic and manual TKA. The secondary objective was to explore comparative robotic and manual TKA pain and opioid consumption outcomes. Multi-database literature searches were performed to identify studies comparing robotic and manual TKA from 2016 to 2022 and meta-analyses were conducted. This review included 50 studies with meta-analyses conducted on 35. Compared with manual TKA, robotic TKA was associated with a: 14% reduction in hospital length of stay (P = 0.022); 74% greater likelihood to be discharged to home (P < 0.001); and 17% lower likelihood to experience a 90-day readmission (P = 0.043). Robotic TKA was associated with longer mean operating times (incision to closure definition: 9.27 min longer, P = 0.030; general operating time definition: 18.05 min longer, P = 0.006). No differences were observed for total procedure cost and 90-day emergency room visits. Most studies reported similar outcomes for robotic and manual TKA regarding pain and opioid use. Coupled with the clinical benefits of robotic TKA, the economic impact of using robotics may contribute to hospitals' quality improvement and financial sustainability. Further research and more randomized controlled trials are needed to effectively quantify the benefits of robotic relative to manual TKA. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate differences in rehabilitation-specific outcomes between paediatric patients, adolescents and young adults within the first 2 years after anterior cruciate ligament (ACL) reconstruction. A further aim was to determine whether patient age was associated with an increased risk of not achieving symmetrical muscle function within the first 2 years after ACL reconstruction. Methods: The patient data in the present study were extracted from the rehabilitation outcome registry, Project ACL. Patients aged 11–25 years registered for primary ACL reconstruction with a hamstring tendon autograft between April 1, 2013 and November 23, 2020 were included. A total of 691 patients met the inclusion criteria and were included in the study; 41 paediatric patients (females 11–13, males 11–15 years), 347 adolescents (females 14–19, males 16–19 years) and 303 young adults (females 20–25, males 20–25 years). Results: The comparison between groups revealed that 70% of paediatric patients, 39% of adolescents and 35% of young adults had returned to knee-strenuous sport at 8 months and that 90% of paediatric patients, 71% of adolescents and 62% of young adults had returned to sport at 12 months. Paediatric patients also reported higher scores compared with both the other patient groups on the Knee Self-Efficacy Scale (K-SES) and the Anterior Cruciate Ligament Return to Sport after Injury scale (ACL-RSI) at 8 and 12 months. Conclusions: A larger proportion of paediatric patients had returned to sport compared with adolescents and young adults 8 and 12 months after ACL reconstruction. Paediatric patients also reported higher self-efficacy and greater psychological readiness to return to sport at 8 and 12 months than the other two groups. No differences in terms of muscle function tests when comparing paediatric patients, adolescents and young adults were found. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the coronal plane alignment of the knee (CPAK) phenotypes of individuals with knee osteoarthritis (OA) progression. We hypothesized that distributions of CPAK phenotypes would be similar throughout OA progression, despite arithmetic hip–knee–ankle angle (aHKA) and joint line obliquity (JLO) changing. Methods: A total of 248 patients (79 men and 169 women) participated in the first study in 2012 and the fifth study in 2020. Patients with progression of knee OA for eight years were included. Knee OA progression was defined as advancement from KL grade 0–2 to KL grade 3 or 4. Alignment parameters, including the aHKA, JLO, hip–knee–ankle angle (HKA), lateral distal femur angle (LDFA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA), were measured. Changes in distribution of CPAK classifications and alignment parameters were investigated. Alignment parameters were compared using a paired t-test. Statistical significance was defined as p < 0.05. Results: The study included 48 patients (60 knees). The distributions of all CPAK phenotypes were similar between 2012 and 2020. MPTA (83.7° ± 2.8° vs. 82.3° ± 4.8°, p < 0.01), aHKA (− 3.6° ± 3.8° vs. − 4.9° ± 6.2°, p = 0.01), and JLO (171.1° ± 4.6° vs. 169.5° ± 5.1°, p < 0.01) decreased significantly, and JLCA (1.17° ± 2.2° vs. 3.1° ± 4.7°, p < 0.01) and HKA (4.8° ± 3.9° vs. 8.0° ± 5.4°, p < 0.01) increased significantly. In contrast, LDFA (87.4° ± 3.2° vs. 87.2° ± 3.1°, p = n.s.) did not change significantly. Conclusions: The CPAK classification system can predict constitutional alignment, even with knee OA progression, and enables surgeons to perform individualized preoperative alignment planning according to knee phenotypes. [ABSTRACT FROM AUTHOR]

Purpose: In revision total knee arthroplasty (TKA) ligament instability and bone defects might require more constraint implants such as a condylar constrained knee (CCK) or rotating hinged knee (RHK). When both implants are suitable, the choice remains controversial. The purpose of this systematic review and meta-analysis was to compare the survivorship and clinical outcome between CCK and RHK in revision TKA. Methods: Systematic literature research was performed. Studies analysing the clinical outcome and/or survivorship of CCK and/or RHK in revision TKA were included. Clinical outcomes included the Knee Society Score, both clinical (KSCS) and functional (KSFS), range of motion (ROM) and reoperations. Survival was defined as the time free from removal or revision of the femoral and/or tibial component. Results: A total of 40 articles analysing 4.555 knees were included. Survival did not differ between RHK and CCK implants (p = 0.6058), with, respectively, 91.6% and 89.8% survival after 5 years. Postoperative KSCS and KSFS were, respectively, 79.2 (SD 10.7) and 61.1 (SD 21.8) for the CCK group. Similar scores were noted for the RHK group with a KSCS of 80.2 (SD 14.1) and KSFS of 58.5 (SD 17.3). Postoperative ROM was similar for CCK (105.3°, SD 17.1°) and RHK patients (104.1°, SD 16.9°). Conclusion: This meta-analysis revealed that both survivorship and clinical outcome are similar for CCK and RHK patients for whom both designs are technically suitable and indicated. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Context: Performance on single-leg hopping (SLH) assessments is commonly included within return-to-sport criteria for rehabilitating athletes. Triaxial accelerometers have been used to quantify impact loading in a variety of movements, including hopping; however, they have never been attached to the tibia during SLH, and their method of fixation has not been investigated. Objective: The purpose of this study was to quantify triaxial accelerations and evaluate the influence of the fixation method of a lightweight inertial measurement unit (Blue Trident) mounted to the tibia during SLH performance. Design: Single cohort, repeated-measures experimental design. Participants: Sixteen healthy participants (10 females and 6 males; 20 [0.9] y; 1.67 [0.08] m; 66.0 [8.5] kg) met the inclusion criteria, volunteered, and completed this study. Interventions: Participants performed 2 sets of 3 SLH trials with an inertial measurement unit (1500 Hz) fixated to the tibia, each set with 1 of 2 attachment methods (double-sided tape [DST] with athletic tape and silicon strap [SS] with Velcro adhesion). Main Outcome Measures: Hop distance, peak tibial acceleration (PTA), time to PTA, and the acceleration slope were assessed during each hop landing. Results: Repeated-measures analysis of variance determined no significant effect of the attachment method on hop metrics (P =.252). Across 3 trials, both fixation methods (DST and SS) had excellent reliability values (intraclass correlation coefficient:.868–.941) for PTA and acceleration slope but not for time to PTA (intraclass correlation coefficient:.397–.768). The PTA for DST (27.22 [7.94] g) and SS (26.21 [10.48] g) was comparable and had a moderate, positive relationship (DST: r =.72, P <.01; SS: r =.77, P <.01) to SLH distance. Conclusions: Tibial inertial measurement units with triaxial accelerometers can reliably assess PTA during performance of the SLH, and SS is a viable alternative tibial attachment to DST. [ABSTRACT FROM AUTHOR]

Purpose: The study hypothesized that the addition of lateral extra-articular tenodesis (LEAT) in anterior cruciate ligament reconstruction (ACLR) had a significant effect on ACL graft healing., Methods: A total of 80 patients were divided into two cohorts matched for gender, age, body mass index, time from surgery to post-operative MRI and graft diameter. Forty patients underwent ACL reconstruction alone, while 40 underwent ACLR in addition to LEAT. Patients underwent a magnetic resonance imaging scan at 12 months post-surgery; tunnel apertures were measured using multiplanar reformation, graft healing was assessed using signal-to-noise quotient (SNQ) in three regions of interest and finally graft maturity and integration were classified using the Howell and Ge scale, respectively. In addition, clinical evaluation and patient-reported outcome measures were collected., Results: The mean femoral tunnel widening at 12 months post-surgery was 39.8 ± 14.0% in the ACLR + LEAT group and 55.2 ± 12.7% in the ACLR alone group (p < 0.05). The mean tibial tunnel widening was 29.3 ± 12.7% in the ACLR + LEAT group and 44.4 ± 12.1% in the ACLR group (p < 0.05). The mean adjusted graft SNQ was 9.0 ± 14.9 in the ACLR + LEAT group and 9.5 ± 11.4 in the ACLR group (n.s.)., Conclusion: At 1 year post-operatively, we noted significantly less femoral and tibial tunnel widening in the ACLR + LEAT group. LEAT did not result in a statistically significant effect on graft healing., Level of Evidence: Level III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: Sickle cell disease (SCD) is a global hemoglobinopathy; approximately 300 000 individuals are diagnosed annually. Acute chest syndrome (ACS), a common complication, leads to significant hospitalization and mortality, particularly in cases of severe respiratory distress. ECMO outcomes in this specific population are poorly described., Methods: This retrospective observational study, utilizing data from the Extracorporeal Life Support Organization (ELSO) registry, focuses on children and young adults (<40 years) with SCD undergoing ECMO from 1998 to 2022., Results: We observed a growing trend in ECMO cases over the last 15 years, with 210 SCD patients identified in the registry (five neonates, 95 children, 110 adults). ECMO was predominantly initiated for pulmonary support (62%), and most of the primary diagnoses were related to SCD (reported as "SCD" or "acute chest syndrome"). The global survival rate was 55.8% (59% for children and 52.7% for adults). None of the children supported for extracorporeal cardiopulmonary resuscitation survived, and only 2/18 (11%) of adults cannulated for ECPR survived. Complication rates, including acute renal failure (33.8%) neurological events (13%), thrombotic (23.3%), or bleeding events (22.9%) were not noticeably different from reported outcomes in the ELSO registry., Conclusion: Our findings suggest that ECMO outcomes in SCD patients align with general ECMO trends and may not be limited by suspected unfavorable results in children and young adults. Despite limitations, our study contributes valuable insights into using ECMO in SCD, emphasizing the need for further research and understanding in this underexplored domain., (© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

For more than 60 years, humans have travelled into space. Until now, the majority of astronauts have been professional, government agency astronauts selected, in part, for their superlative physical fitness and the absence of disease. Commercial spaceflight is now becoming accessible to members of the public, many of whom would previously have been excluded owing to unsatisfactory fitness or the presence of cardiorespiratory diseases. While data exist on the effects of gravitational and acceleration (G) forces on human physiology, data on the effects of the aerospace environment in unselected members of the public, and particularly in those with clinically significant pathology, are limited. Although short in duration, these high acceleration forces can potentially either impair the experience or, more seriously, pose a risk to health in some individuals. Rather than expose individuals with existing pathology to G forces to collect data, computational modelling might be useful to predict the nature and severity of cardiovascular diseases that are of sufficient risk to restrict access, require modification, or suggest further investigation or training before flight. In this Review, we explore state-of-the-art, zero-dimensional, compartmentalized models of human cardiovascular pathophysiology that can be used to simulate the effects of acceleration forces, homeostatic regulation and ventilation-perfusion matching, using data generated by long-arm centrifuge facilities of the US National Aeronautics and Space Administration and the European Space Agency to risk stratify individuals and help to improve safety in commercial suborbital spaceflight., (© 2024. Springer Nature Limited.)

Knee osteoarthritis (KOA) significantly contributes to the global disability burden, with its incidence expected to escalate by 74.9% by 2050. The urgency to comprehend and tackle this condition is critical, necessitating an updated and thorough review of KOA. A systematic review up to February 26, 2024, has elucidated the principal aspects of KOA's pathogenesis, risk factors, clinical manifestations, and contemporary management paradigms. The origins of KOA are intricately linked to mechanical, inflammatory, and metabolic disturbances that impair joint function. Notable risk factors include age, obesity, and previous knee injuries. Diagnosis predominantly relies on clinical assessment, with radiographic evaluation reserved conditionally. The significance of rehabilitation assessments, informed by the International Classification of Functioning, Disability, and Health framework, is highlighted. Treatment strategies are diverse, prioritizing nonpharmacological measures such as patient education, exercise, and weight management, with pharmacological interventions considered adjuncts. Intra-articular injections and surgical options are contemplated for instances where conventional management is inadequate. KOA stands as a predominant disability cause globally, characterized by a complex etiology and profound effects on individuals' quality of life. Early, proactive management focusing on nonpharmacological interventions forms the cornerstone of treatment, aiming to alleviate symptoms and enhance joint function. This comprehensive review underscores the need for early diagnosis, individualized treatment plans, and the integration of rehabilitation assessments to optimize patient outcomes. Further research is needed to refine prevention strategies and improve management outcomes for KOA patients., (© 2024 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.)

Purpose: During cycling, the variation in cardiac stroke volume (SVV) is similar to that at rest. However, SVV may be influenced by ventilation at the start of cycling, e.g., by a Valsalva-like maneuver used to stabilize the body. This study evaluated the influence of ventilation on SV during initiation of cycling., Methods: Ten healthy recreationally physical active males (mean ± SD: age 26 ± 3 years, height 184 ± 9 cm, weight 85 ± 9 kg) cycled on an ergometer for four 30 s intervals at submaximal workloads while synchronizing ventilatory and cardiovascular variables derived from gas exchange and arterial pulse contour analysis, respectively., Results: At exercise onset, cardiac output increased by an instantaneous rise in heart rate and SV (P < 0.05). In contrast, blood pressure increased only after 15 s (P < 0.05), reflected in a decline in total peripheral resistance from exercise onset (P < 0.05). SVV was similar at rest (20 ± 6%) and during exercise (21 ± 5%) except for the first 5 s of exercise when a ~ 2.5-fold elevation (47 ± 6%; P < 0.05) was correlated to variation in respiratory frequency (= 0.71, P = 0.02) and tidal volume (R = 0.66, P = 0.04) but not to variation in heart rate or blood pressure. Stepwise multiple regression analysis indicated a respiratory frequency influence on SVV at the onset of ergometer cycling., Conclusion: The data provide evidence for a ventilatory influence on SVV at the onset of cycling exercise., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The aim of this study was to analyze the learning curve of total operative time, bone cutting accuracy, and limb alignment in total knee arthroplasty (TKA) using a Chinese image-based knee surgery robot known as HURWA. Additionally, a comparison was conducted with conventional TKA to ascertain the benefits of robotic-assisted TKA. Methods: In this retrospective study, we analyzed a series of patients (n = 90) who underwent robotic-assisted total knee arthroplasty using the HURWA robot between December 2021 and October 2022. The procedures were performed by one of three orthopedic surgeons with varying levels of experience. As a control group, we selected the last 30 conventional TKA cases performed by each of these three surgeons. To determine the learning curve, we recorded the operative time, bone cutting error, and pre- and post-surgery radiographs. Results: The study found no significant differences in total operative time, bone cutting accuracy, or limb alignment among the three surgeons. Of the three surgeons, surgeon 1, who had the most experience in joint arthroplasty, reached the learning curve in case 8, with the shortest bone cutting time and robot time. Surgeon 2 reached the learning curve in case 16, while surgeon 3 reached the learning curve in case 9. There was no observable learning curve effect for bone cutting accuracy and limb alignment. However, the percentage of cases where limb alignment differed from preoperative planning by 3° or less was higher in robotic-assisted TKA (77.97%) than in conventional TKA (47.19%). Conclusion: The study determined that the learning curve for robotic-assisted TKA using the HURWA knee surgery robot ranged from 8 to 20 cases. No observable learning curve effect was detected for bone cutting accuracy or limb alignment. Experienced surgeons using the HURWA robot for bone cutting took less time and reached the learning curve earlier. The HURWA robot achieved better limb alignment without depending on the experience of conventional TKA. [ABSTRACT FROM AUTHOR]

Background: Based on the controversy surrounding pulmonary artery catheterization (PAC) in surgical patients, we investigated the interchangeability of cardiac index (CI) and systemic vascular resistance (SVR) measurements between ClearSight™ and PAC during living-donor liver transplantation (LDLT). Methods: This prospective study included consecutively selected LDLT patients. ClearSight™-based CI and SVR measurements were compared with those from PAC at seven LDLT-stage time points. ClearSight™-based systolic (SAP), mean (MAP), and diastolic (DAP) arterial pressures were also compared with those from femoral arterial catheterization (FAC). For the comparison and analysis of ClearSight™ and the reference method, Bland-Altman analysis was used to analyze accuracy while polar and four-quadrant plots were used to analyze the trending ability. Results: From 27 patients, 189 pairs of ClearSight™ and reference values were analyzed. The CI and SVR performance errors (PEs) exhibited poor accuracy between the two methods (51.52 and 51.73%, respectively) in the Bland-Altman analysis. CI and SVR also exhibited unacceptable trending abilities in both the polar and four-quadrant plot analyses. SAP, MAP, and DAP PEs between the two methods displayed favorable accuracy (24.28, 21.18, and 26.26%, respectively). SAP and MAP exhibited acceptable trending ability in the four-quadrant plot between the two methods, but not in the polar plot analyses. Conclusions: During LDLT, CI and SVR demonstrated poor interchangeability, while SAP and MAP exhibited acceptable interchangeability between ClearSight™ and FAC. [ABSTRACT FROM AUTHOR]

The introduction of robot-assisted (RA) systems in knee arthroplasty has challenged surgeons to adopt the new technology in their customized surgical techniques, learn system controls, and adjust to automated processes. Despite the potential advantages of RA knee arthroplasty, some surgeons remain hesitant to adopt this novel technology owing to concerns regarding the cumbersome adaptation process. This narrative review addresses the learning-curve issues in RA knee arthroplasty based on the existing literature. Learning curves exist in terms of the operative time and stress level of the surgical team but not in the final implant positions. The factors that reduce the learning curve are previous experience with computer-assisted surgery (including robot or navigation systems), specialization in knee surgery, high volume of knee arthroplasty, optimization of the RA workflow, sequential implementation of RA surgery, and consistency of the surgical team. Worse clinical outcomes may occur in the early postoperative period, but not in the later period, in RA knee arthroplasty performed during the learning phase. No significant differences were observed in implant survival or complication rates between the RA knee arthroplasties performed during the learning and proficiency phases. [ABSTRACT FROM AUTHOR]

Background and objectives: Our study aimed to assess the learning curve for robot-assisted (RA) total knee arthroplasty (TKA) in our hospital, compare operative times between RA-TKAs and manual TKAs, and assess the early complications rate between the two approaches. Methods: We included 39 patients who underwent RA-TKA and 45 control patients subjected to manual TKA in the same period and operated on by the same surgical staff. We collected demographic and patient-related data to assess potential differences between the two groups. Results: No statistical differences were recorded in regard to age, BMI, sex, Kellgren–Lawrence classification, or limb alignment between patients undergoing RA-TKA and manual TKA, respectively. Three surgeons transitioned from the learning to the proficiency phase in our study after a number of 6, 4, and 3 cases, respectively. The overall operative time for the learning phase was 111.54 ± 20.45 min, significantly longer compared to the average of 86.43 ± 19.09 min in the proficiency phase (p = 0.0154) and 80.56 ± 17.03 min for manual TKAs (p < 0.0001). No statistically significant difference was recorded between the global operative time for the proficiency phase TKAs versus the controls. No major complications were recorded in either RA-TKA or manual TKA groups. Conclusions: Our results suggest that experienced surgeons may adopt RA-TKA using this platform and quickly adapt without significant complications. [ABSTRACT FROM AUTHOR]

This study investigates the effects of core training on some strength, lower extremity functions, and balance performances in judoka. The study was based on a two-group pretest-posttest experimental design with repeated measures. The study included 12 female (F) judo athletes aged 12-18 years and 10 male (M) judo athletes aged 12-17 years. Three measurements for core strength (push-ups, planks, sit-ups), six different single leg hop tests (SLHT) for lower extremity muscle strength and YBT for balance were performed before and after 6-week core training. Shapiro-Wilk, Levene, and Paired sample t-tests were used in statistical analyses. The increases in limb symmetry index (LSI) scores were remarkable. When the push-up and plank times and sit-up scores of F and M participants were compared with the pre-test, a significant increase was observed in favor of the post-test. When we examined the dominant (D) leg hop for distance, we found that M and F judoka's SLD, THD, MSTHD, MRHD, and CHD post-test scores all increased (except F; CHD) and also M and F showed better performance in SL6MD. Similar performance outputs were seen in the non-dominant (ND) leg hop for distance measurements (only not changed F; THND). Finally, it was valuable to note that both right and left leg YBT scores showed a considerable rise in the post-test assessments. As a result, core exercise practices may improve the sit-up score by improving the time in push-ups and planks in judoka. In addition, it may improve balance performance by affecting lower extremity functions. [ABSTRACT FROM AUTHOR]

Background: While clinical and patient-reported outcomes have been investigated in patients after InternalBrace™-augmented anterior cruciate ligament repair (ACL-IB), less is known regarding restoration of functional performance. We aimed to determine differences in functional performance within and between patients 2 years after ACL-IB, patients 2 years after ACL reconstruction (ACL-R), and healthy controls. Materials and Methods: A total of 29 ACL-IB, 27 ACL-R (hamstring autograft), and 29 controls performed single-leg hop (maximum forward distance hop, SLH; side hop > 40 cm in 30 s, SH), proprioception (knee joint position sense at 30° and 60° flexion), and dynamic postural balance (Y Balance) tests. Differences were calculated within groups (side-to-side difference) and between the involved leg of patients and the non-dominant leg of controls, and were evaluated to predefined statistical (P < 0.05), clinically relevant, and methodological (smallest detectable change) thresholds. The number of exceeded thresholds represented no (0), small (1), moderate (2), or strong (3) differences. In addition, the relative number of participants achieving leg symmetry (≥ 90%) and normal performance (≥ 90% of the average performance of the non-dominant leg of controls) were compared between groups (chi-squared tests, P < 0.05). Results: We observed no-to-moderate leg differences within ACL-IB (moderate difference in hops) and within ACL-R (moderate difference in knee proprioception), no leg differences between patient groups, no-to-small leg differences between ACL-IB and controls, and no leg differences between ACL-R and controls in functional performance. However, two patients in ACL-IB and ACL-R, respectively, passed the hop pretest only with their uninvolved leg, and fewer patients after ACL-IB and ACL-R than controls reached a leg symmetry and normal leg performance of controls in SLH (P < 0.001). Conclusions: Functional performance seems to be comparable 2 years postoperatively between ACL-IB and ACL-R for a specific subgroup of patients (i.e., proximal ACL tears, moderate activity level). However, the presumed advantage of comparable functional outcome with preserved knee structures after augmented ACL repair compared with ACL-R, and the tendency of both patient groups toward leg asymmetry and compromised single-leg hop performance in the involved legs, warrants further investigation. Level of Evidence Level III, case-control study. Trial registration clinicaltrials.gov, NCT04429165 (12/09/2020). Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT04429165. [ABSTRACT FROM AUTHOR]

PURPOSE Single-leg landings are common in sport and often result in injury, however a rubric to evaluate biomechanics during single-leg jump landing (SLL) does not exist. The Single-Leg Landing Error Scoring System (SL-LESS) is a rubric developed to evaluate movement during SLL. The purpose of this study was to 1) determine inter- and intra-rater reliability of the SL-LESS, 2) and determine the content and construct validity of the SL-LESS when evaluating SLL METHOD 28 healthy females completed SLL on two days while 2D and 3D data were recorded. 3D angles were trunk flexion/lateral-flexion, pelvic tilt/contralateral drop, hip flexion/adduction, and knee flexion/abduction at initial contact (IC) and maximum knee flexion (MKF). Two raters used the SL-LESS rubric to score 2D videos each day. Participants were grouped by total SL-LESS score (≤ 2 errors=good; ≥4 errors=poor landers). Kappa, prevalence- and bias-adjusted kappa (PABAK), and percent agreement were calculated for inter- and intra-rater reliability between rubric items. Total score reliability was evaluated using an ICC. Differences in 3D angles, knee abduction moment(KABDM), and vertical ground reaction force(vGRF)between good and poor landers were evaluated using a one-way ANOVA (construct validity). p RESULTS SL-LESS item inter-rater (Average κ=0.21±0.21, PABAK=0.60±0.28, % agreement=0.78±0.13); and intra-rater (Average Κ=0.30±0.21, PABAK=0.60±0.21, %agreement= 0.79±0.12) reliability were moderate. Inter- (ICC(2,1)=0.50) and intra-rater (ICC(3,1)=0.56) reliability for total score were moderate. Good landers displayed significantly greater hip and trunk flexion at IC, and hip and knee flexion at MKF, lower KABDM at initial contact, and lower vGRF (p CONCLUSIONS The SL-LESS can reliably be used to evaluate the SLL movement and can discriminate between “stiff” landings with upright posture and high impact force from “soft” landings with flexed landing posture with lower impact force. [ABSTRACT FROM AUTHOR]

Purpose: Robotic arm-assisted total knee arthroplasty (raTKA), currently a major trend in knee arthroplasty, aims to improve the accuracy of implant positioning and limb alignment. However, it is unclear whether and to what extent manual radiographic and navigation measurements with the MAKO™ system correlate. Nonetheless, a high agreement would be crucial to reliably achieve the desired limb alignment. Methods: Thirty-six consecutive patients with osteoarthritis and a slight-to-moderate varus deformity undergoing raTKA were prospectively included in this study. Prior to surgery and at follow-up, a full leg radiograph (FLR) under weight-bearing conditions was performed. In addition, a computed tomography (CT) scan was conducted for preoperative planning. The hip–knee–ankle angle (HKA), mechanical lateral distal femur angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and joint line convergence angle (JLCA) were measured in the preoperative and follow-up FLR as well as in the CT scout (without weight-bearing) by three independent raters. Furthermore, the HKA was intraoperatively assessed with the MAKO™ system before and after raTKA. Results: Significantly higher HKA values were identified for intraoperative deformity assessment using the MAKO system compared to the preoperative FLR and CT scouts (p = 0.006; p = 0.05). Intraoperative assessment of the HKA with final implants showed a mean residual varus deformity of 3.2° ± 1.9°, whereas a significantly lower residual varus deformity of 1.4° ± 1.9° was identified in the postoperative FLR (p < 0.001). The mMPTA was significantly higher in the preoperative FLR than in the CT scouts (p < 0.001). Intraoperatively, the mMPTA was adjusted to a mean of 87.5° ± 0.9° with final implants, while significantly higher values were measured in postoperative FLRs (p < 0.001). Concerning the mLDFA, no significant differences could be identified. Conclusion: The clinical importance of this study lies in the finding that there is a difference between residual varus deformity measured intraoperatively with the MAKO™ system and those measured in postoperative FLRs. This has implications for preoperative planning as well as intraoperative fine-tuning of the implant position during raTKA to avoid overcorrection of knees with slight-to-moderate varus osteoarthritis. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Brain perfusion is sensitive to changes in CO2 levels (CO2 reactivity). Previously, we showed a pathological cerebral blood flow (CBF) reduction in the majority of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients during orthostatic stress. Limited data are available on the relation between CO2 and CBF changes in ME/CFS patients. Therefore, we studied this relation between ME/CFS patients and healthy controls (HC) during tilt testing. In this retrospective study, supine and end‐tilt CBF, as measured by extracranial Doppler flow, were compared with PETCO2 data in female patients either with a normal heart rate and blood pressure (HR/BP) response or with postural orthostatic tachycardia syndrome (POTS), and in HC. Five hundred thirty‐five female ME/CFS patients and 34 HC were included. Both in supine position and at end‐tilt, there was a significant relation between CBF and PETCO2 in patients (p < 0.0001), without differences between patients with a normal HR/BP response and with POTS. The relations between the %CBF change and the PETCO2 reduction were both significant in patients and HC (p < 0.0001 and p = 0.0012, respectively). In a multiple regression analysis, the patient/HC status and PETCO2 predicted CBF. The contribution of the PETCO2 to CBF changes was limited, with low adjusted R2 values. In female ME/CFS patients, CO2 reactivity, as measured during orthostatic stress testing, is similar to that of HC and is independent of the type of hemodynamic abnormality. However, the influence of CO2 changes on CBF changes is modest in female ME/CFS patients. [ABSTRACT FROM AUTHOR]

Intradialytic hypotension, defined as rapid decrease in systolic blood pressure of greater than or equal to 20 mmHg or in mean arterial pressure of greater than or equal to 10 mmHg that results in end-organ ischemia and requires countermeasures such as ultrafiltration reduction or saline infusion to increase blood pressure to improve patient's symptoms, is a known complication of hemodialysis and is associated with several potential adverse outcomes. Its pathogenesis is complex and involves both patient-related factors such as age and comorbidities, as well as factors related to the dialysis prescription itself. Key factors include the need for volume removal during hemodialysis and a suboptimal vascular response which compromises the ability to compensate for acute intravascular volume loss. Inadequate vascular refill, incorrect assessment or unaccounted changes of target weight, acute illnesses and medication interference are further potential contributors. Intradialytic hypotension can lead to compromised tissue perfusion and end-organ damage, both acutely and over time, resulting in repetitive injuries. To address these problems, a careful assessment of subjective symptoms, minimizing interdialytic weight gains, individualizing dialysis prescription and adjusting the dialysis procedure based on patients' risk factors can mitigate negative outcomes. [ABSTRACT FROM AUTHOR]

Objective gait analysis provides valuable information about the locomotion characteristics of sound and lame horses. Due to their high accuracy and sensitivity, inertial measurement units (IMUs) have gained popularity over objective measurement techniques such as force plates and optical motion capture (OMC) systems. IMUs are wearable sensors that measure acceleration forces and angular velocities, providing the possibility of a non-invasive and continuous monitoring of horse gait during walk, trot, or canter during field conditions. The present narrative review aimed to describe the inertial sensor technologies and summarize their role in equine gait analysis. The literature was searched using general terms related to inertial sensors and their applicability, gait analysis methods, and lameness evaluation. The efficacy and performance of IMU-based methods for the assessment of normal gait, detection of lameness, analysis of horse–rider interaction, as well as the influence of sedative drugs, are discussed and compared with force plate and OMC techniques. The collected evidence indicated that IMU-based sensor systems can monitor and quantify horse locomotion with high accuracy and precision, having comparable or superior performance to objective measurement techniques. IMUs are reliable tools for the evaluation of horse–rider interactions. The observed efficacy and performance of IMU systems in equine gait analysis warrant further research in this population, with special focus on the potential implementation of novel techniques described and validated in humans. [ABSTRACT FROM AUTHOR]

Arterial pulse waves (PWs) such as blood pressure and photoplethysmogram (PPG) signals contain a wealth of information on the cardiovascular (CV) system that can be exploited to assess vascular age and identify individuals at elevated CV risk. We review the possibilities, limitations, complementarity, and differences of reduced-order, biophysical models of arterial PW propagation, as well as theoretical and empirical methods for analyzing PW signals and extracting clinically relevant information for vascular age assessment. We provide detailed mathematical derivations of these models and theoretical methods, showing how they are related to each other. Finally, we outline directions for future research to realize the potential of modeling and analysis of PW signals for accurate assessment of vascular age in both the clinic and in daily life. [ABSTRACT FROM AUTHOR]

Hypotension can occur before, during, and after surgery and is associated with postoperative complications. Anesthesiologists should thus avoid profound and prolonged hypotension. A crucial part of avoiding hypotension is accurate and tight blood pressure monitoring. In this narrative review, we briefly describe methods for continuous blood pressure monitoring, discuss current evidence for continuous blood pressure monitoring in patients having surgery to reduce perioperative hypotension, and expand on future directions and innovations in this field. In summary, continuous blood pressure monitoring with arterial catheters or noninvasive sensors enables clinicians to detect and treat hypotension immediately. Furthermore, advanced hemodynamic monitoring technologies and artificial intelligence—in combination with continuous blood pressure monitoring—may help clinicians identify underlying causes of hypotension or even predict hypotension before it occurs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the effect of vestibular sympathetic activation on estimated measures of central (aortic) hemodynamic load in young adults. Thirty-one participants (n = 14 females and 17 males) underwent cardiovascular measures in the prone position with the head in a neutral position and during 10 min of head-down rotation (HDR), as a means of activating the vestibular sympathetic reflex. Radial pressure waveforms were acquired via applanation tonometry and, with the use of a generalized transfer function, used to synthesize an aortic pressure waveform. Popliteal vascular conductance was derived from diameter and flow velocity measured via Doppler-ultrasound. Subjective orthostatic intolerance was assessed using a 10-item orthostatic hypotension questionnaire. There was a reduction in brachial systolic blood pressure (BP) during HDR (111 ± 10 vs. 109 ± 9 mmHg, P < 0.05), but there was no change in aortic systolic BP (100 ± 9 vs. 99 ± 8 mmHg, P > 0.05). Aortic augmentation index (-5 ± 11 vs. -12 ± 12%, P < 0.05) and reservoir pressure (28 ± 8 vs. 26 ± 8 mmHg, P < 0.05) were reduced with a concomitant reduction in popliteal conductance (5.6 ± 0.7 vs. 4.5 ± 0.7 mL/min·mmHg, P < 0.05). Change in aortic systolic BP was associated with subjective orthostatic intolerance score (r = -0.39, P < 0.05). Activation of the vestibular sympathetic reflex via HDR resulted in slight reductions in brachial BP concomitant with preservation of aortic BP. Despite peripheral vascular constriction during HDR, there was a reduction in pressure from wave reflections and reservoir pressure. Finally, there was an association between change in aortic systolic BP during HDR and orthostatic intolerance score, suggesting that individuals who cannot defend against drops in aortic BP during vestibular sympathetic reflex activation may be more likely to experience higher subjective symptomatology of orthostatic intolerance. [ABSTRACT FROM AUTHOR]

Neurological outcome after ischemic stroke depends on residual salvageable brain tissue at the time of recanalization. Head down tilt 15° (HDT15) was proven effective in reducing infarct size and improving functional outcome in rats with transient middle cerebral artery occlusion (t‐MCAO) by increasing cerebral perfusion within the ischemic penumbra. In this pooled analysis, individual animal‐level data from three experimental series were combined in a study population of 104 t‐MCAO rats (45 in HDT15 group and 59 in flat position group). Co‐primary outcomes were infarct size and functional outcome at 24 h in both groups. The secondary outcome was hemodynamic change induced by HDT15 in ischemic and non‐ischemic hemispheres in a subgroup of animals. Infarct size at 24 h was smaller in HDT15 group than in flat position group (absolute mean difference 31.69 mm3, 95% CI 9.1–54.2, Cohen's d 0.56, p = 0.006). Functional outcome at 24 h was better in HDT15 group than in flat position group (median [IQR]: 13[10–16] vs. 11), with a shift in the distribution of the neurobehavioural scores in favour of HDT15. Mean cerebral perfusion in the ischemic hemisphere was higher during HDT15 than before its application (Perfusion Unit [P.U.], mean ± SD: 52.5 ± 19.52 P.U. vs. 41.25 ± 14.54 P.U., mean of differences 13.36, 95% CI 7.5–19.18, p = 0.0002). Mean cerebral perfusion in the non‐ischemic hemisphere before and during HDT15 was unchanged (P.U., mean ± SD: 94.1 ± 33.8 P.U. vs. 100.25 ± 25.34 P.U., mean of differences 3.95, 95%, CI −1.9 to 9.6, p = 0.1576). This study confirmed that HDT15 improves the outcome in t‐MCAO rats by promoting cerebral perfusion in the ischemic territory, without disrupting hemodynamics in non‐ischemic areas. [ABSTRACT FROM AUTHOR]

Introduction: Robotic systems have been introduced to improve the precision of total knee arthroplasty. However, different robotic systems are available, each with unique features used to plan and execute the surgery. As such, due to this diversity, the clinical evaluation of each robotic platform should be separated. Methods: An extensive literature search of PubMed, Medline, Embase and Web of Science was conducted with subsequent meta-analysis. Randomised controlled trials, comparative studies, and cohort studies were included regarding robot-assisted total knee arthroplasty. Evaluated outcomes included clinical results, surgical precision, ligament balance, surgical time, learning curve, complications and revision rates. These were split up based on the robot-specific brand: ROBODOC (T-SOLUTION ONE), OMNIBOT, MAKO, NAVIO (CORI) and ROSA. Results: With a follow-up of more than 10 years, no improved clinical outcomes have been noted with the ROBODOC system compared to the conventional technique. If available, other platforms only present short-term clinical outcomes. Radiological outcomes are published for most robotic setups, demonstrating improved surgical precision compared to the conventional technique. Gap balance assessment is performed differently between all systems, leading to heterogeneous outcomes regarding its relationship on clinical outcomes. There is a similar learning curve based on operative time for all robotic platforms. In most studies, robot assistance requires longer operative time compared to the conventional technique. Complications and revision rates are published for ROBODOC and MAKO, without clear differences to conventional total knee arthroplasty. Conclusion: The main finding of this systematic review is that the current evidence regarding each robotic system is diverse in quantity and quality. Each system has its own specificities and must be assessed for its own value. Regarding scientific literature, the generic term of robotic should be banned from the general conclusion. Level of evidence: Systematic review level IV. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluates the accuracy of continuous blood pressure monitoring using pulse contour technology with the ClearSight monitoring device, a noninvasive alternative to placing an invasive arterial line, in pediatric patients., Methods: Children younger than 18 years admitted to a pediatric ICU, who required an arterial line, and fit into the ClearSight finger cuff were included. Blood pressure measurement for systolic, diastolic, and mean arterial pressures (MAP) obtained by the ClearSight device were compared with those obtained with the intra-arterial catheter as well as automated cuff measurements using the mixed-effects model. Analysis was conducted for entire cohort, and measurements obtained with and without vasopressor use., Results: There were 213 measurements from 10 patients. There was a statistically significant difference in systolic blood pressure when comparing arterial line and ClearSight systolic and diastolic measurements between the two methods (P < 0.001). There was no statistical difference between arterial MAP and ClearSight MAP (P = 0.957). Results were similar when ClearSight measurements were compared with automated cuff measurements. Both the vasopressor use and nonvasopressor use groups showed a statistically significant difference between arterial and ClearSight measurements for systolic and diastolic pressures, but not for the MAP., Conclusions: Measurements of MAP obtained by the ClearSight device were almost identical to those obtained by the intra-arterial catheter. Although there was a difference in systolic blood pressures between the two methods, in those patients receiving inotropic support, the difference was within the range of what is considered acceptable in validating blood pressure devices.

Purpose: The study aimed to evaluate the impact of neurocognitive reliance on jump distance and lower extremity kinematics in individuals who had undergone anterior cruciate ligament reconstruction (ACLR). This was achieved by comparing hop performance under standard and neurocognitive conditions., Methods: Thirty-two patients after ACLR and 32 healthy controls (CTRL) participated. Both groups performed a single-leg hop for distance (SLHD) and two neurocognitive hop tests, each designed to evaluate distinct aspects of neurocognition. The neurocognitive tests included the reaction SLHD (R-SLHD), measuring reaction to a central stimulus and working memory SLHD (WM-SLHD) assessing response to a memorized stimulus amidst distractor stimuli. Distances were assessed for the three-hop tests. In addition, joint kinematics were collected to calculate lower extremity coordination of the lower extremity. SLHD performance was defined as the mean hop distance per condition per leg for each participant and was analyzed using a mixed ANOVA with condition and leg as the within-subjects factors and the group (ACLR or CTRL) as the between-subjects factor. Differences in joint coordination variability were analyzed using two-sample t-test statistical parametric mapping (SPM) with linear regression., Results: The WM-SLHD resulted in a significantly decreased jump distance compared with the standard hop test both for ACLR and CTRL. Furthermore, the leg difference within the ACLR group increased under higher cognitive load as tested with the WM-SLHD, indicating leg-specific adaptations in lower extremity coordination., Conclusions: Neurocognitive single-leg hop tests resulted in reduced jump distance in CTRL and ACLR. The neurocognitive hop test revealed changes in coordination variability for the CTRL and the uninjured leg of ACLR individuals, whereas the injured leg's coordination variability remained unaltered, suggesting persistent cognitive control of movements post-ACLR., Level of Evidence: Level III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: The ability of current return-to-sport (RTS) tests to predict second anterior cruciate ligament (ACL) injuries (ACLI) in athletes with a history of ACL reconstruction (ACLR) is unclear. This study aimed to prospectively assess the risk of a second ACLI by identifying the most significant deviation in hop test results in professional athletes after ACLR compared to healthy peers., Methods: A total of 30 professional athletes with a history of ACLR and 30 healthy professional athletes participated in this study. Participants performed 10 functional hop tests, and the subsequent limb symmetry index (LSI) was compared between the groups. After a 3-year follow-up, the re-injury rate was assessed among the ACLR group. Fourteen ACLR athletes who sustained a second ACLI were included and matched with 14 controls from the healthy group. The LSI and the hop distance to body height percentage (D/H) were compared between the groups., Results: Statistical analyses confirmed a significant decrease in LSI in the ACLR group compared to the healthy group in the triple hop for distance (p = .023). In re-injured ACLR athletes, seven different hop tests showed a significant decrease in the D/H index compared to the healthy controls. Meanwhile, for LSI, only the triple cross-over hop for distance (p = .045) showed a significant increase in the healthy group., Conclusion: Before clearing athletes for RTS, assessing functional hop test results using the hop distance to body height ratio, aligned with normative data from healthy controls, could further enhance the prediction of reduced graft rupture risk., Level of Evidence: Level I., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: The purpose of this study was to study the relationship between the presence of a deep lateral femoral notch sign (DLFNS) in anterior cruciate ligament (ACL)-injured patients and a higher posterior lateral tibial slope (LPTS), a reduced meniscal bone angle (MBA), a higher LPTS/MBA ratio and a higher incidence of concomitant injuries in primary ACL tears., Methods: A retrospective case-control study was performed in patients submitted to primary ACL reconstruction with an available preoperative magnetic resonance imaging (MRI) scan. Patients with ACL tears and a femoral impactation with a depth ≥2 mm were assorted to the DLFNS group and patients with ACL tear and without a DLFNS to the control group. LPTS and MBA were measured in MRI. The presence of concomitant injuries (meniscal, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament and bone injuries) was assessed in MRI. Quantitative data are presented in the median ± interquartile range (IQR)., Results: There were 206 patients included in the study, with 46 patients assorted to the DLFNS group and 160 patients to the control group. In the DLFNS group, the median LPTS was 6.7° (IQR: 4.0-8.2) versus 4.0° in the control group (IQR: 2.2-6.5) (p = 0.003). The LPTS/MBA ratio was significantly higher in the DLFNS group, with a median of 0.32 (IQR: 0.19-0.44), in comparison to the control group, with a median of 0.19 (IQR: 0.11-0.31) (p < 0.001). The multivariable logistic regression analysis showed that the LPTS is an independent risk factor to having a DLFNS (odds ratio [OR] = 1.161; 95% confidence interval [CI]: 1.042-1.293, p = 0.007). There was a higher incidence of concomitant lateral meniscal injuries in the DLFNS group (67% vs. 48%, p = 0.017)., Conclusions: In patients with ACL tears, the presence of a DLFNS is associated with a steeper lateral posterior tibial slope, as well as a higher incidence of concomitant lateral meniscal injuries., Level of Evidence: Level III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: To assess children's physical function and subjective knee status 1 and 3 years after anterior cruciate ligament (ACL) reconstruction. It was hypothesised that there was no difference between the operated and normal legs in relation to physical strength and function, that there was <-2 mm side-to-side difference in knee laxity, and that the subjective knee function was better 3 years after ACL reconstruction compared to 1 year after., Methods: Children (<16 years of age) who had an ACL reconstruction had follow-up with physical function tests (four hop tests and strength measurement in a power rig [PR]), anterior knee laxity (measured using a Rolimeter) and patient-reported outcome measures (Pedi-International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]-Child) 1 and 3 years postoperatively. Changes from 1- to 3-year follow-up were evaluated with a paired t test., Results: Out of 148 ACL reconstructed children, 60 had all measures. The four hop tests and the PR all yielded a Limb Symmetry Index >90% at both follow-ups. There was a significant improvement from 1- to 3-year follow-up in two-hop tests (6 m on time and crossover hop). Side-to-side knee laxity was >2 mm in four children at 1- and 3-year tests. Pedi-IKDC scores increased, and KOOS-Child improved significantly from 1 to 3 years in two of the five domains: 'Sport' and 'Quality of life', but scores were lower than in a cohort of normal children., Conclusion: The children had good objective physical function 1 and 3 years after ACL reconstruction. However, scores from the KOOS-Child sport-specific function and quality of life domains were lower than in normal children., Level of Evidence: Level II., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Hydraulic consistency between a prototype pump and its hydraulic model is generally considered to be satisfied, that is, the energy performance and the flow structures conform to the similarity law. However, such hydraulic consistency may not always exist in actual engineering projects. Head change and vibration enhancement in large-scale bulb tubular pumps are exhibited, but the reason for this inconsistency is still unclear. In this article, a case study was performed for the South-to-North Water Diversion Project in China, and the pressure characteristics in the impeller were explored under the optimal condition. An interesting new phenomenon, pressure polarization oscillation, is found. Its most important feature is the constant difference in average pressure values among axisymmetric blades, that is, the blades with axisymmetric structures exhibit large-amplitude pressure oscillations around different average pressure values, and one revolution is equivalent to one rotating cycle due to the failure of hydraulic consistency. Further in-depth analysis reveals that pressure oscillations are realized by the adjustment of the resultant force between the Coriolis force and the potential rothalpy gradient to fluid motions under the sinusoidal disturbance of gravity, and its action path presents a hysteresis loop with the impeller rotating. This adjustment mode leads to a special conversion between the gravity potential energy, pressure energy, and the kinetic energy, and, thus, the hydrostatic pressure difference at the initial phase cannot be fully eliminated; the pressure transition between the sides along and against the gravity is inconsistent. This finding suggests that the difference induced by the hydraulic inconsistency should be considered if the conventional similarity conversion is applied to large-scale tubular pumps. [ABSTRACT FROM AUTHOR]

Background: Autoregulation of the cerebral vasculature keeps brain perfusion stable over a range of systemicmean arterial pressures to ensure brain functioning, e.g., in different body positions. Verticalization, i.e., transfer from lying (0°) to upright (70°), which causes systemic blood pressure drop, would otherwise dramatically lower cerebral perfusion pressure inducing fainting. Understanding cerebral autoregulation is therefore a prerequisite to safe mobilization of patients in therapy. Aim: We measured the impact of verticalization on cerebral blood flow velocity (CBFV) and systemic blood pressure (BP), heart rate (HR) and oxygen saturation in healthy individuals. Methods: Wemeasured CBFV in themiddle cerebral artery (MCA) of the dominant hemisphere in 20 subjects using continuous transcranial doppler ultrasound (TCD). Subjects were verticalized at 0°, -5°, 15°, 30°, 45° and 70° for 3-5min each, using a standardized Sara Combilizer chair. In addition, blood pressure, heart rate and oxygen saturation were continuously monitored. Results: We show that CBFV progressively decreases in the MCA with increasing degrees of verticalization. Systolic and diastolic BP, as well as HR, show a compensatory increase during verticalization. Conclusion: In healthy adults CBFV changes rapidly with changing levels of verticalization. The changes in the circulatory parameters are similar to results regarding classic orthostasis. [ABSTRACT FROM AUTHOR]

Purpose: Arthrofibrosis after primary total knee arthroplasty (TKA) is a significant contributor to patient dissatisfaction. While treatment algorithms involve early physical therapy and manipulation under anaesthesia (MUA), some patients ultimately require revision TKA. It is unclear whether revision TKA can consistently improve these patient's range of motion (ROM). The purpose of this study was to evaluate ROM when revision TKA was performed for arthrofibrosis. Methods: A retrospective study of 42 TKA's diagnosed with arthrofibrosis from 2013 to 2019 at a single institution with a minimum 2-year follow-up was performed. The primary outcome was ROM (flexion, extension, and total arc of motion) before and after revision TKA, and secondary outcomes included patient reported outcomes information system (PROMIS) scores. Categorical data were compared using chi-squared analysis, and paired samples t tests were performed to compare ROM at three different times: pre-primary TKA, pre-revision TKA, and post-revision TKA. A multivariable linear regression analysis was performed to assess for effect modification on total ROM. Results: The patient's pre-revision mean flexion was 85.6 degrees, and mean extension was 10.1 degrees. At the time of the revision, the mean age of the cohort was 64.7 years, the average body mass index (BMI) was 29.8, and 62% were female. At a mean follow-up of 4.5 years, revision TKA significantly improved terminal flexion by 18.4 degrees (p < 0.001), terminal extension by 6.8 degrees (p = 0.007), and total arc of motion by 25.2 degrees (p < 0.001). The final ROM after revision TKA was not significantly different from the patient's pre-primary TKA ROM (p = 0.759). PROMIS physical function, depression, and pain interference scores were 39 (SD = 7.72), 49 (SD = 8.39), and 62 (SD = 7.25), respectively. Conclusion: Revision TKA for arthrofibrosis significantly improved ROM at a mean follow-up of 4.5 years with over 25 degrees of improvement in the total arc of motion, resulting in final ROM similar to pre-primary TKA ROM. PROMIS physical function and pain scores showed moderate dysfunction, while depression scores were within normal limits. While physical therapy and MUA remain the gold standard for the early treatment of stiffness after TKA, revision TKA can improve ROM. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Variation during practice is widely accepted to be advantageous for motor learning and is, therefore, a valuable strategy to effectively reduce high-risk landing mechanics and prevent primary anterior cruciate ligament (ACL) injury. Few attempts have examined the specific effects of variable training in athletes who have undergone ACL reconstruction. Thereby, it is still unclear to what extent the variations in different sensor areas lead to different effects. Accordingly, we compared the effects of versatile movement variations (DL) with variations of movements with emphasis on disrupting visual information (VMT) in athletes who had undergone ACL reconstruction. Forty-five interceptive sports athletes after ACL reconstruction were randomly allocated to a DL group (n = 15), VT group (n = 15), or control group (n = 15). The primary outcome was functional performance (Triple Hop Test). The secondary outcomes included dynamic balance (Star Excursion Balance Test (SEBT)), biomechanics during single-leg drop-landing task hip flexion (HF), knee flexion (KF), ankle dorsiflexion (AD), knee valgus (KV), and vertical ground reaction force (VGRF), and kinesiophobia (Tampa Scale of Kinesiophobia (TSK)) assessed before and after the 8 weeks of interventions. Data were analyzed by means of 3 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of p ≤ 0.05. Significant group × time interaction effects, main effect of time, and main effect of group were found for the triple hop test and all eight directions, SEBT, HF, KF, AD, KV, VGRF, and TSK. There was no significant main effect of group in the HF and triple hop test. Additionally, significant differences in the triple hop test and the seven directions of SEBT, HF, KF, KV, VGRF, and TSK were found between the control group and the DL and VMT groups. Between group differences in AD and the medial direction of SEBT were not significant. Additionally, there were no significant differences between VMT and the control group in the triple hop test and HF variables. Both motor learning (DL and VMT) programs improved outcomes in patients after ACL reconstruction. The findings suggest that DL and VMT training programs lead to comparable improvements in rehabilitation. [ABSTRACT FROM AUTHOR]