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Purpose: Despite the publication of several randomized controlled trials (RCTs), it is not clear which technique for the treatment of focal chondral and osteochondral defects of the knee grants the best clinical outcome. The aim of this network meta-analysis (NMA) was to compare the efficacy and safety of microfractures (MF), autologous chondrocyte implantation (ACI), autologous matrix-induced chondrogenesis (AMIC), osteochondral autograft transplantation (OCT) at short (< 1 year), intermediate (1–5 years) and long-term (> 5 years). Methods: We carried out an NMA with Bayesian random-effect model, according to PRISMA guidelines. The search was performed in MEDLINE, EMBASE, Web of Science, CENTRAL, CINAHL, SPORTDiscus, clinicaltrials.gov, WHO ICTRP, from inception to November 2022. The eligibilities were randomized controlled trials on patients with knee chondral and osteochondral defects, undergoing microfractures, OCT, AMIC, ACI, without restrictions for prior or concomitant surgery on ligaments, menisci or limb alignment, prior surgery for fixation or ablation of osteochondritis dissecans fragments, and prior cartilage procedures as microfractures, drilling, abrasion, or debridement. Results: Nineteen RCTs were included. No difference among treatments was shown in the pooled comparison of patient reported outcome measures (PROMs) at any timepoint. Safety data were not available for all trials due to the heterogeneity of reporting, but chondrospheres seemed to have lower failure and reoperation rates. Conclusion: This NMA showed no difference for PROMs with any technique. The lower failure and reoperation rates with chondrospheres must be interpreted with caution since adverse event data was heterogenous among trials. The standardization of the efficacy and safety outcome measures for future trials on knee cartilage repair and regeneration is necessary.

Nitrogen oxides (NOx), significant contributors to air pollution and climate change, form aerosols and ozone in the atmosphere. Accurate, timely, and transparent information on NOx emissions is essential for decision-making to mitigate both haze and ozone pollution. However, a comprehensive understanding of the trends and drivers behind anthropogenic NOx emissions from China—the world's largest emitter—has been lacking since 2020 due to delays in emissions reporting. Here we show a consistent decline in China's NOx emissions from 2020 to 2022, despite increased fossil fuel consumption, utilizing satellite observations as constraints for NOx emission estimates through atmospheric inversion. This reduction is corroborated by data from two independent spaceborne instruments: the TROPOspheric Monitoring Instrument (TROPOMI) and the Ozone Monitoring Instrument (OMI). Notably, a reduction in transport emissions, largely due to the COVID-19 lockdowns, slightly decreased China's NOx emissions in 2020. In subsequent years, 2021 and 2022, reductions in NOx emissions were driven by the industry and transport sectors, influenced by stringent air pollution controls. The satellite-based inversion system developed in this study represents a significant advancement in the real-time monitoring of regional air pollution emissions from space.

Abstract Background Arthroplasty registries are rarely used to inform encounters between clinician and patient. This study is part of a larger one which aimed to develop an information tool allowing both to benefit from previous patients’ experience after total hip arthroplasty (THA). This study focuses on generating the information tool specifically for pain outcomes. Methods Data from the Geneva Arthroplasty Registry (GAR) about patients receiving a primary elective THA between 1996 and 2019 was used. Selected outcomes were identified from patient and surgeon surveys: pain walking, climbing stairs, night pain, pain interference, and pain medication. Clusters of patients with homogeneous outcomes at 1, 5, and 10 years postoperatively were generated based on selected predictors evaluated preoperatively using conditional inference trees (CITs). Results Data from 6,836 THAs were analysed and 14 CITs generated with 17 predictors found significant (p

Abstract Half of osteoporotic fractures occur in patients with normal/osteopenic bone density or at intermediate or low estimated risk. Muscle measures have been shown to contribute to fracture risk independently of bone mineral density. The objectives were to review the measurements of muscle health (muscle mass/quantity/quality, strength and function) and their association with incident fragility fractures and to summarize their use in clinical practice. This scoping review follows the PRISMA‐ScR guidelines for reporting. Our search strategy covered the three overreaching concepts of ‘fragility fractures’, ‘muscle health assessment’ and ‘risk’. We retrieved 14 745 references from Medline Ovid SP, EMBASE, Web of Science Core Collection and Google Scholar. We included original and prospective studies on community‐dwelling adults aged over 50 years that analysed an association between at least one muscle parameter and incident fragility fractures. We systematically extracted 17 items from each study, including methodology, general characteristics and results. Data were summarized in tables and graphically presented in adjusted forest plots. Sixty‐seven articles fulfilled the inclusion criteria. In total, we studied 60 muscle parameters or indexes and 322 fracture risk ratios over 2.8 million person‐years (MPY). The median (interquartile range) sample size was 1642 (921–5756), age 69.2 (63.5–73.6) years, follow‐up 10.0 (4.4–12.0) years and number of incident fragility fractures 166 (88–277). A lower muscle mass was positively/not/negatively associated with incident fragility fracture in 28 (2.0), 64 (2.5) and 10 (0.2 MPY) analyses. A lower muscle strength was positively/not/negatively associated with fractures in 53 (1.3), 57 (1.7 MPY) and 0 analyses. A lower muscle function was positively/not/negatively associated in 63 (1.9), 45 (1.0 MPY) and 0 analyses. An in‐depth analysis shows how each single muscle parameter was associated with each fragility fractures subtype. This review summarizes markers of muscle health and their association with fragility fractures. Measures of muscle strength and function appeared to perform better for fracture risk prediction. Of these, hand grip strength and gait speed are likely to be the most practical measures for inclusion in clinical practice, as in the evaluation of sarcopenia or in further fracture risk assessment scores. Measures of muscle mass did not appear to predict fragility fractures and might benefit from further research, on D3‐creatine dilution test, lean mass indexes and artificial intelligence methods.

Background and purpose: Younger recipients of total hip arthroplasty (THA) highly prioritize returning to preoperative levels of physical activity (PA). Surgeons have tended to give cautious advice concerning high-impact sports participation, but there have been few long-term studies. The purpose of our study was to investigate the risk of revision arthroplasty in relation to postoperative PA levels. Methods: Patients registered in the Geneva Arthroplasty Register (GAR) who had elective THA when they were aged < 65 years were studied. Postoperative PA was collected prospectively 5-yearly using the UCLA activity scale. Cox proportional hazards models were used to estimate associations between PA and risk of revision THA. Results: Amongst 1,370 eligible subjects, median age at THA 58 years (interquartile range 51–61), UCLA scores were available for 973 (71%). During follow-up over 15 years, there were 79 revisions, giving a cumulative risk of 7.4% (95% confidence interval [CI] 5.8–9.4). After adjusting for covariates, we found an increased risk of revision for each unit increase in postoperative PA (HR 1.2, CI 1.1–1.4), and among people performing the most intensive PA (HR 2.7, CI 1.3–5.6) compared with those who were inactive. Conclusion: The overall risk of revision was small but intensive and moderate PA may be associated with an increased risk of revision.

Objective To test the effect of a complex, interdisciplinary, lifestyle and psychosocial intervention on metabolic and mental health outcomes in women with gestational diabetes mellitus during pregnancy and in the post partum.Design Single centred, single blinded, randomised, controlled trial (the MySweetheart trial).Setting Lausanne University Hospital, Switzerland, from 2 September 2016 to 25 October 2021.Participants 211 women aged at least 18 years with a diagnosis of gestational diabetes mellitus at 24-32 gestational weeks were randomly assigned (1:1) to the intervention (n=105) or to usual care (n=106).Interventions In addition to a comparator based on active guidelines for prepartum and postpartum usual care, the intervention consisted of four individual lifestyle visits during pregnancy and four interdisciplinary visits in the postpartum group, a peer support group workshop in pregnancy and post partum, and a bimonthly lifestyle coach support through telemedicine. The intervention focused on tailored behavioural and psychosocial strategies to improve diet, physical activity, mental health, social support, and adherence to gestational weight gain during pregnancy and weight retention recommendations.Main outcome measures Primary outcomes were between-group differences in the decrease in maternal weight and depression symptom scores between baseline and one year post partum. Secondary outcomes included changes in total and central body fat, anxiety, wellbeing, glycaemic parameters (homeostatic model assessment for insulin resistance (known as HOMA-IR) and Matsuda indices), aerobic fitness (maximal oxygen uptake), gestational weight gain, and weight retention. Assessors were blinded to primary and secondary outcomes.Results 84 (80%) of 105 women in the intervention and 95 (90%) of 106 in the usual care completed the study. There was not enough evidence of a difference in the decrease in weight (mean difference –0.38 kg (95% confidence interval –2.08 to 1.30)) or depression scores (–0.67 (–1.84 to 0.49)). The intervention led to an increase in fat-free mass (0.02 kg (0.01 to 0.03)). The intervention also decreased gestational weight gain since the first gestational diabetes mellitus visit (–1.20 kg (–2.14 to –0.26)) and weekly weight gain throughout the entire pregnancy (–0.14 kg (–0.25 to –0.03)), and led to a higher proportion of women without weight retention at one year post partum (34.1% (28/82) v 20.8% (20/96), P=0.034).Conclusions Compared with active usual care based on guidelines, there was not enough evidence to conclude that the intervention led to decrease in weight or depression symptoms. However, the intervention decreased gestational weight gain and increased the proportion of women without weight retention.Trial registration Clinicaltrials.gov NCT02890693.

Summary: Human genetic studies of critical COVID-19 pneumonia have revealed the essential role of type I interferon-dependent innate immunity to SARS-CoV-2 infection. Conversely, an association between the HLA-B∗15:01 allele and asymptomatic SARS-CoV-2 infection in unvaccinated individuals was recently reported, suggesting a contribution of pre-existing T cell-dependent adaptive immunity. We report a lack of association of classical HLA alleles, including HLA-B∗15:01, with pre-omicron asymptomatic SARS-CoV-2 infection in unvaccinated participants in a prospective population-based study in the United States (191 asymptomatic vs. 945 symptomatic COVID-19 cases). Moreover, we found no such association in the international COVID Human Genetic Effort cohort (206 asymptomatic vs. 574 mild or moderate COVID-19 cases and 1,625 severe or critical COVID-19 cases). Finally, in the Human Challenge Characterisation study, the three HLA-B∗15:01 individuals infected with SARS-CoV-2 developed symptoms. As with other acute primary infections studied, no classical HLA alleles favoring an asymptomatic course of SARS-CoV-2 infection were identified.

Objective A vital component of a prehospital emergency care system is getting an injured patient to the right hospital at the right time. Process and information flow mapping are recognised methods to show where efficiencies can be made. We aimed to understand the process and information flows used by the prehospital emergency service in transporting community emergencies in Rwanda in order to identify areas for improvement.Design Two facilitated process/information mapping workshops were conducted. Process maps were produced in real time during discussions and shared with participants for their agreement. They were further validated by field observations.Setting The study took place in two prehospital care settings serving predominantly rural and predominantly urban patients.Participants 24 healthcare professionals from various cadres. Field observations were done on 49 emergencies across both sites.Results Two maps were produced, and four main process stages were described: (1) call triage by the dispatch/call centre team, (2) scene triage by the ambulance team, (3) patient monitoring by the ambulance team on the way to the health facility and (4) handover process at the health facility. The first key finding was that the rural site had multiple points of entry into the system for emergency patients, whereas the urban system had one point of entry (the national emergency number); processes were otherwise similar between sites. The second was that although large amounts of information were collected to inform decision-making about which health facility to transfer patients to, participants found it challenging to articulate the intellectual process by which they used this to make decisions; guidelines were not used for decision-making.Discussion We have identified several areas of the prehospital care processes where there can be efficiencies. To make efficiencies in the decision-making process and produce a standard approach for all patients will require protocolising care pathways.

Abstract Background The capacity of skeletal muscles to regenerate relies on Pax7+ muscle stem cells (MuSC). While in vitro-amplified MuSC are activated and lose part of their regenerative capacity, in vitro-generated human muscle reserve cells (MuRC) are very similar to quiescent MuSC with properties required for their use in cell-based therapies. Methods In the present study, we investigated the heterogeneity of human MuRC and characterized their molecular signature and metabolic profile. Results We observed that Notch signaling is active and essential for the generation of quiescent human Pax7+ MuRC in vitro. We also revealed, by immunofluorescence and flow cytometry, two distinct subpopulations of MuRC distinguished by their relative Pax7 expression. After 48 h in differentiation medium (DM), the Pax7High subpopulation represented 35% of the total MuRC pool and this percentage increased to 61% after 96 h in DM. Transcriptomic analysis revealed that Pax7High MuRC were less primed for myogenic differentiation as compared to Pax7Low MuRC and displayed a metabolic shift from glycolysis toward fatty acid oxidation. The bioenergetic profile of human MuRC displayed a 1.5-fold decrease in glycolysis, basal respiration and ATP-linked respiration as compared to myoblasts. We also observed that AMPKα1 expression was significantly upregulated in human MuRC that correlated with an increased phosphorylation of acetyl-CoA carboxylase (ACC). Finally, we showed that fatty acid uptake was increased in MuRC as compared to myoblasts, whereas no changes were observed for glucose uptake. Conclusions Overall, these data reveal that the quiescent MuRC pool is heterogeneous for Pax7 with a Pax7High subpopulation being in a deeper quiescent state, less committed to differentiation and displaying a reduced metabolic activity. Altogether, our data suggest that human Pax7High MuRC may constitute an appropriate stem cell source for potential therapeutic applications in skeletal muscle diseases.

Abstract Background Total hip arthroplasty is a widely performed surgical procedure, which enables patients to regain mobility, alleviates pain, and improves overall quality of life. Periarticular multimodal drug infiltration (PAI) is increasingly being used as an effective postoperative pain management, decreasing the systemic consumption of opioids. Extensive postoperative skin necrosis without a deep joint infection as a complication of total hip arthroplasty with PAI has not yet been described. Case presentation A 71-year-old patient who underwent total hip arthroplasty of the right hip for primary osteoarthritis through the Direct Anterior Approach presented postoperatively a large area of necrotic skin at the incision. Joint infection was excluded. An extensive debridement was performed and the tissue defect was reconstructed by a pedicled anterolateral thigh flap. The skin maintained a satisfactory appearance at 1 year postoperatively, and the hip was pain-free with restored ranges of motion. The patient was able to walk with no support and without limitation. Conclusion We address the possible risk factors, discuss the use of epinephrine in PAI and explore possible treatment options for such a complication.

Abstract With increasing global interest in molecular hydrogen to replace fossil fuels, more attention is being paid to potential leakages of hydrogen into the atmosphere and its environmental consequences. Hydrogen is not directly a greenhouse gas, but its chemical reactions change the abundances of the greenhouse gases methane, ozone, and stratospheric water vapor, as well as aerosols. Here, we use a model ensemble of five global atmospheric chemistry models to estimate the 100-year time-horizon Global Warming Potential (GWP100) of hydrogen. We estimate a hydrogen GWP100 of 11.6 ± 2.8 (one standard deviation). The uncertainty range covers soil uptake, photochemical production of hydrogen, the lifetimes of hydrogen and methane, and the hydroxyl radical feedback on methane and hydrogen. The hydrogen-induced changes are robust across the different models. It will be important to keep hydrogen leakages at a minimum to accomplish the benefits of switching to a hydrogen economy.

Background and purpose: We aimed to evaluate the long-term predictive value of radiographic abnormality and/or hip pain assessed 5 years following primary total hip arthroplasty (THA) and the occurrence of revision for aseptic loosening between 5 and 25 years postoperatively. Patients and methods: We included all primary THAs performed between 1996 and 2011 (same uncemented cup, polyethylene-ceramic bearing, 28 mm head, cemented stem) and prospectively enrolled in the institutional registry, for whom baseline and follow-up radiographs were available. At 5 years radiographically we assessed femoral osteolysis and/or stem migration. Pain was evaluated with the Harris Hip pain subscore. Kaplan–Meier survival and Cox regression analyses were performed. Results: 1,317 primary THAs were included. 25 THAs (2%) were revised for aseptic stem loosening. Any abnormal radiographic sign at 5 years was present in 191 THAs (14%). Occasional hip pain was reported by 20% and slight to severe pain by 12% of patients at 5 years. In patients < 60 years, 10 of the 12 later revised for aseptic stem loosening had abnormal radiographs at 5 years vs. 5 of the 13 later revised in those ≥ 60 years. Hazard ratios (HR) were 34 (95% confidence interval [CI] 7–155) in younger vs. 4 (CI 1–11) in the older group. HR for association of hip pain at 5 years with future revision was 3 (CI 1–5). Conclusion: The presence of abnormal radiographic signs 5 years after THA was strongly associated with later revision for aseptic stem loosening, especially in patients < 60 years. The association between pain at 5 years and future revision was much weaker.

Abstract Background APP duplication is a rare genetic cause of Alzheimer disease and cerebral amyloid angiopathy (CAA). We aimed to evaluate the phenotypes of APP duplications carriers. Methods Clinical, radiological, and neuropathological features of 43 APP duplication carriers from 24 French families were retrospectively analyzed, and MRI features and cerebrospinal fluid (CSF) biomarkers were compared to 40 APP-negative CAA controls. Results Major neurocognitive disorders were found in 90.2% symptomatic APP duplication carriers, with prominent behavioral impairment in 9.7%. Symptomatic intracerebral hemorrhages were reported in 29.2% and seizures in 51.2%. CSF Aβ42 levels were abnormal in 18/19 patients and 14/19 patients fulfilled MRI radiological criteria for CAA, while only 5 displayed no hemorrhagic features. We found no correlation between CAA radiological signs and duplication size. Compared to CAA controls, APP duplication carriers showed less disseminated cortical superficial siderosis (0% vs 37.5%, p = 0.004 adjusted for the delay between symptoms onset and MRI). Deep microbleeds were found in two APP duplication carriers. In addition to neurofibrillary tangles and senile plaques, CAA was diffuse and severe with thickening of leptomeningeal vessels in all 9 autopsies. Lewy bodies were found in substantia nigra, locus coeruleus, and cortical structures of 2/9 patients, and one presented vascular amyloid deposits in basal ganglia. Discussion Phenotypes associated with APP duplications were heterogeneous with different clinical presentations including dementia, hemorrhage, and seizure and different radiological presentations, even within families. No apparent correlation with duplication size was found. Amyloid burden was severe and widely extended to cerebral vessels as suggested by hemorrhagic features on MRI and neuropathological data, making APP duplication an interesting model of CAA.

• Offsets in the frontal plane are important for hip function. • Research on total hip arthroplasty (THA) surgery agrees that increasing femoral offset up to 5 mm could improve functional outcome measures. • The literature indicates that global offset is a key parameter that physicians should restore within 5 mm during surgery and avoid decreasing. • Substantiated findings on acetabular offset are lacking despite its recognized importance, and the medialization approach must be assessed in light of its shortcomings. • Future research, possibly through improved measurement, unified definitions, patientspecific surgical planning, and technology-enhanced surgical control, with specific focus on acetabular offset, is needed to better understand its impact on THA outcomes.

Abstract The importance of the global offset, the sum of femoral and acetabular offset, has been underlined in the literature as a key factor for the functional outcome of total hip arthroplasty (THA). However, the acetabular offset is not defined for bi-plane X-rays, a technology providing 3D measurements of the lower limb and commonly used for patients undergoing THA. The aim of this paper is to introduce a measurement method of the 3D acetabular offset with bi-plane X-rays. Our method combines the use of technical and anatomical coordinate systems. The most appropriate definition will be selected based on the best reliability and measurement error. The consequent reliability of the global offset was also assessed. Twenty-eight patients undergoing primary THA were selected retrospectively. Two operators performed three reconstructions for each patients before and after THA. Intraclass correlation (ICC) and smallest detectable change (SDC) were computed for intra-operator, inter-operator and test–retest conditions for all combinations of technical and anatomical coordinate systems. ICCs were good to excellent. One combination was more reliable than others with a moderate mean SDC of 6.3 mm (4.3–8.7 mm) for the acetabular offset and a moderate mean SDC of 6.2 mm (5.6–6.7 mm) for the global offset. This is similar to the reliability and mean SDC of the femoral offset (4.8 mm) approved for clinical use which indicates that this method of acetabular offset measurement is appropriate. This opens a research avenue to better understand the role of the acetabular offset on THA outcomes, which seems overlooked in the literature.

Abstract Bi-plane X-ray provides 3D measurements of the lower limb based on the identification of anatomical landmarks in sagittal and frontal X-rays. In clinical practice, such measurements involve multiple operators and sessions. This study aimed at evaluating the reliability of anatomical landmarks identification and geometric parameters of the pelvis and femur measured with bi-plane X-rays before and after total hip arthroplasty (THA). Twenty-eight patients undergoing primary THA were selected retrospectively. Two operators performed three reconstructions for each patient before and after THA. Intraclass correlation (ICC) and smallest detectable change (SDC) were computed for intra-operator, inter-operator, and test–retest conditions. Most anatomical landmark positions had good to excellent SDC (

Transitioning to a hydrogen economy has the potential to mitigate carbon dioxide emissions. The hydrogen leakage rate and the production pathways appear, based on simulations with a global model, as key leverages to reach a clear climate benefit from a large-scale transition to a hydrogen economy.

Introduction: Lipedema is a poorly known condition. Diagnosis is based almost exclusively on clinical criteria, which may be subjective and not always reliable. This study aimed to investigate regional body composition (BC) by dual-energy X-ray absorptiometry (DXA) in patients with lipedema and healthy controls and to determine cut-off values of fat mass (FM) indices to provide an additional tool for the diagnosis and staging of this condition. Methods: This study is a single-center case-control study performed at Lausanne University Hospital, Switzerland. Women with clinically diagnosed lipedema underwent regional BC assessment by DXA. The control group without clinical lipedema was matched for age and body mass index (BMI) at a ratio of 1:2 and underwent similar examination. Regional FM (legs, arms, legs and arms, trunk, android and gynoid FM) was measured in (kg) and divided by FM index (FMI) (kg/m2) and total FM (kg). The trunk/legs and android/gynoid ratios were calculated. For all indices of FM distribution showing a significant difference between cases and controls, we defined the receiver operating characteristic (ROC) curves, calculating the area under the curve (AUC), sensitivity, specificity, and Youden’s index. Types and stages of lipedema were compared in terms of FM indices. Correlation analyses between all FM distribution indices and lipedema stages were performed. Results: We included 222 women (74 with lipedema and 148 controls). Overall, the mean age was 41 years (standard deviation [SD] 11), and mean BMI was 30.9 kg/m2 (SD 7.6). A statistically significant difference was observed for all DXA-derived indices of FM distribution between groups, except for arm FM indices. The ROC curve analysis of leg FM/total FM, as a potential indicator of lipedema, resulted in an AUC of 0.90 (95% confidence interval 0.86–0.94). According to Youden’s index, optimal cut-off value identifying lipedema was 0.384. Sensitivity and specificity were 0.95 and 0.73, respectively. We found no significant differences between lipedema types and stages in terms of FM indices, nor significant correlations between the latter and lipedema stages. Discussion/Conclusion: BC assessment by DXA, and particularly calculation of the leg FM/total FM index, is a simple tool that may help clinicians rule out lipedema in doubtful cases.

Thermal energy represents more than half of the energy needs of European industry, but is still misspent in processes as waste heat, mostly between 100 and 200 °C. Waste heat recovery and reuse provide carbon-free heat and reduce production costs. The industrial sector is seeking affordable and rugged solutions that should adapt the heat recovery to heat demand. This study aims to identify suitable latent heat materials to reach that objective: the selected candidates should show good thermal performance that remains stable after aging and, in addition, be at a reasonable price. This paper details the selection process and aging results for two promising phase change materials (PCMs): adipic and sebacic acid. They showed, respectively, melting temperatures around 150 °C and 130 °C, degradation temperatures (mass lost higher than 1%) above 180 °C, and volumetric enthalpy of 95 and 75 kWh·m−3. They are both compatible with the stainless steel 316L while their operating temperature does not exceed 15 °C above the melting temperature, but they do not comply with the industrial recommendation for long-term use in contact with the steel P265GH (corrosion speed > 0.2 mm·year−1).

Inertial measurement units (IMUs) need sensor-to-segment calibration to measure human kinematics. Multiple methods exist, but, when assessing populations with locomotor function pathologies, multiple limitations arise, including holding postures (limited by joint pain and stiffness), performing specific tasks (limited by lack of selectivity) or hypothesis on limb alignment (limited by bone deformity and joint stiffness). We propose a sensor-to-bone calibration based on bi-plane X-rays and a specifically designed fusion box to measure IMU orientation with respect to underlying bones. Eight patients undergoing total hip arthroplasty with bi-plane X-rays in their clinical pathway participated in the study. Patients underwent bi-plane X-rays with fusion box and skin markers followed by a gait analysis with IMUs and a marker-based method. The validity of the pelvis, thigh and hip kinematics measured with a conventional sensor-to-segment calibration and with the sensor-to-bone calibration were compared. Results showed (1) the feasibility of the fusion of bi-plane X-rays and IMUs in measuring the orientation of anatomical axes, and (2) higher validity of the sensor-to-bone calibration for the pelvic tilt and similar validity for other degrees of freedom. The main strength of this novel calibration is to remove conventional hypotheses on joint and segment orientations that are frequently violated in pathological populations.

Abstract Background Distal ulna head or neck fracture is commonly associated with distal radius fracture. Treatment of these fractures remains controversial. Plate osteosynthesis is commonly performed. The purpose of this study was to observe clinical and radiological outcomes in ulna hook plate osteosynthesis for distal ulna fracture associated with distal radius fracture. Materials and methods This retrospective study between 2010 and 2018 included patients presenting combined displaced distal ulna fracture and distal radius fracture who were treated with ulna hook plate osteosynthesis. Patient evaluation included pain measurement with the visual analog scale, wrist range of motion, grip and pinch strengths, Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and Mayo wrist score. Preoperative radiographs were reviewed to classify the distal ulna fracture according to Biyani. Bone union was evaluated on postoperative X-rays. At final follow-up, the usual radiographic parameters were measured and distal radioulnar joint (DRUJ) osteoarthritis was assessed. Results A total of 48 patients were included. Mean age was 63 years old and mean follow-up was 28 months. According to the Biyani classification, there were 12 type I, 4 type II, 8 type III, and 24 type IV distal ulna fractures. Wrist flexion was 60°, extension 57°, pronation 85°, and supination 80°. Grip strength was 21 kg (86% of the uninjured opposite side). Pinch strength was 6.6 kg (92% of the uninjured opposite side). Clinical scores were very good to excellent, with a mean Q-DASH of 12 and a Mayo wrist score of 90. Discomfort or pain due to the implant that required implant removal was reported in 29%, and was higher in younger patients. Nonunion was observed in two cases and secondary implant displacement in one case. These three cases required secondary intervention with ulna head resection, which was higher in Biyani type IV. DRUJ osteoarthritis was observed in 12 patients (31%) and was higher in older patients. Conclusions Ulna hook plate fixation gives good clinical results and a high rate of fracture union, but complications are common. Implant irritation is a frequent complication, especially in young patients, and often requires implant removal. Level of evidence: IV

Abstract Background Ankle fractures are a common injury and the main cause of post-traumatic ankle arthritis. The prevalence of obesity is increasing worldwide, and this population is known to have poorer short and midterm outcomes after ankle fractures. Our objective is to assess long-term patient-reported outcomes in patients with operatively treated ankle fractures, and the effect of BMI on these results using the new and validated patient-reported outcome questionnaire, the Manchester Oxford foot and ankle questionnaire (MOXFQ). Methods We performed a retrospective review of all ankle fractures treated operatively in a ten-year period from 2002–2012. The MOXFQ and SF-12 were sent to all patients and were obtained, on average, 11.1 years after surgery (range 5.3–16.2 years). Results Two thousand fifty-five ankle fractures were reviewed, of which 478 (34%) patients completed the questionnaires. The mean age was 48.1 ± 15.5 years, 52% were men and the mean BMI was 26.1 ± 4.5 kg/m2. Of the 478, 47% were of normal weight, 36% were overweight, and 17% were obese. Overall, 2.1% were type A, 69.9% B, and 24.9% type C fractures. There were no significant differences in the type of fracture between the BMI groups. Comparing obese and non-obese patients, there were large differences in MOXFQ pain (33 ± 29 vs. 18.7 ± 22.1, effect size 0.55), and function scores (27.3 ± 29 vs. 12.5 ± 21.1, effect size 0.58). No differences in complications and reoperations rates were observed. The BMI value at surgery correlated more strongly with the MOXFQ pain score than the BMI at follow-up (Spearman’s Rho 0.283 vs. 0.185, respectively). Conclusion These findings reveal that obese patients have significant worse long-term outcomes, namely increased pain, poorer function, and greater impairment in everyday life after an operatively treated ankle fracture. Moreover, pain and function linearly declined with increasing BMI. Our findings appear to indicate that increased BMI at surgery is an important contributor to adverse outcome in the operative management of rotational ankle fractures. Level of evidence III.

Little is known about the inflammatory potential of diet and its relation to bone health. This cross-sectional study examined the association between the inflammatory potential of diet and bone-related outcomes in midwestern, post-menopausal women enrolled in the Heartland Osteoporosis Prevention Study (HOPS) randomized controlled trial. Dietary intake from the HOPS cohort was used to calculate Dietary Inflammatory Index (DII®) scores, which were energy-adjusted (E-DIITM) and analyzed by quartile. The association between E-DII and lumbar and hip bone mineral density (BMD) and lumbar trabecular bone scores (TBS; bone structure) was assessed using ANCOVA, with pairwise comparison to adjust for relevant confounders (age, education, race/ethnicity, smoking history, family history of osteoporosis/osteopenia, BMI, physical activity, and calcium intake). The cohort included 272 women, who were predominately white (89%), educated (78% with college degree or higher), with a mean BMI of 27 kg/m2, age of 55 years, and E-DII score of −2.0 ± 1.9 (more anti-inflammatory). After adjustment, E-DII score was not significantly associated with lumbar spine BMD (p = 0.53), hip BMD (p = 0.29), or TBS at any lumbar location (p > 0.05). Future studies should examine the longitudinal impact of E-DII scores and bone health in larger, more diverse cohorts.

Abstract Background Objectives were first to evaluate by education level one-year trajectories of pain, function and general health, as well as hospital resource and medication needs in patients undergoing primary total hip arthroplasty (THA); and second, to evaluate whether outcome differences are related to existing baseline differences in health and disease severity. Methods We included all primary THAs from a public hospital-based prospective arthroplasty registry, performed in a high-income country 2010 to 2017. Education was classified in three levels: ≤8years of schooling (low), 9-12years (medium), and ≥13years (high). Pain and function prior to and one-year after surgery were assessed with the Western Ontario McMaster Universities score (WOMAC) and general health with the 12-item short-form health survey (SF-12). Results Overall 963 patients were included, 340 (35.3%) with low, 306 (31.8%) with medium, and 317 (32.9%) with high education. With increasing educational level preoperative scores for pain, function and SF-12 mental health component increased. One year after surgery improvement was observed in all education categories for WOMAC pain and function, SF-12 mental and physical component. However, absolute postoperative scores remained lower in all four domains for the low education group. After adjustment for baseline characteristics differences were much attenuated and no longer significant. There was also greater resource need in low educated patients. Conclusions The inferior absolute results one year after surgery in less educated patients were largely due to older age, worse preoperative health and greater symptom severity calling for greater attention to timely and equal management, for more targeted perioperative care and increased support for the lower education group.

Objective Low-grade inflammation plays a pivotal role in osteoarthritis (OA) through exposure to reactive oxygen species (ROS). In chondrocytes, NADPH oxidase 4 (NOX4) is one of the major ROS producers. In this study, we evaluated the role of NOX4 on joint homoeostasis after destabilisation of the medial meniscus (DMM) in mice.Methods Experimental OA was simulated on cartilage explants using interleukin-1β (IL-1β) and induced by DMM in wild-type (WT) and NOX4 knockout (NOX4-/-) mice. We evaluated NOX4 expression, inflammation, cartilage metabolism and oxidative stress by immunohistochemistry. Bone phenotype was also determined by micro-CT and histomorphometry.Results Whole body NOX4 deletion attenuated experimental OA in mice, with a significant reduction of the OARSI score at 8 weeks. DMM increased total subchondral bone plate (SB.Th), epiphysial trabecular thicknesses (Tb.Th) and bone volume fraction (BV/TV) in both NOX4-/- and wild-type (WT) mice. Interestingly, DDM decreased total connectivity density (Conn.Dens) and increased medial BV/TV and Tb.Th only in WT mice. Ex vivo, NOX4 deficiency increased aggrecan (AGG) expression and decreased matrix metalloproteinase 13 (MMP13) and collagen type I (COL1) expression. IL-1β increased NOX4 and 8-hydroxy-2'-deoxyguanosine (8-OHdG) expression in WT cartilage explants but not in NOX4-/-. In vivo, absence of NOX4 increased anabolism and decreased catabolism after DMM. Finally, NOX4 deletion decreased synovitis score, 8-OHdG and F4/80 staining following DMM.Conclusion NOX4 deficiency restores cartilage homoeostasis, inhibits oxidative stress, inflammation and delays OA progression after DMM in mice. These findings suggest that NOX4 represent a potential target to counteract for OA treatment.

Background and purpose — Prior to primary total knee arthroplasty (pTKA), 6–34% of patients have undergone surgical procedure(s) of their knee. We investigated whether history of previous surgeries influences the risk of revision of pTKA, the risk according to the type of previous surgery, and how previous surgery influences specific causes of revision and the time of revision. Patients and methods — This is a prospective cohort study from the Geneva Arthroplasty Registry. All pTKA between 2000 and 2016 were included and followed until December 31, 2019. Outcomes were risk of revision, evaluated using Kaplan–Meier survival and Cox and competing risks regression, the specific causes, and time of revision. Results — Of 3,945 pTKA included (mean age 71 years, 68% women), 21% had a history of previous surgery, with 8.3% revisions vs. 4.3%, at 3–20 years’ follow-up (mean 8.6). 5- and 10-year cumulative failure by previous surgery (yes vs. no) were 6.6% (95% CI 5.1–8.5) vs. 3.3% (CI 2.7–4.0), and 8.4% (CI 6.6–10.6) vs. 4.5% (CI 3.8–5.4). Baseline differences explained only part of the higher risk (adjusted HR 1.5, CI 1.1–2.1). The risk of failure was higher for all causes of revision considered. Patients in the previous surgery group had a higher risk of an early revision. Interpretation — A history of previous surgery adversely affected the outcome with a 1.5 times higher cumulative risk of all-cause revision over the course of up to 20 years after index surgery. The increased risk was seen for all causes of revision and was highest in the first years.

ABSTRACT The hematopoietic stem cell niche constitutes a complex bone marrow (BM) microenvironment. Osteoporosis is characterized by both reduced bone mineral density (BMD) and microarchitectural deterioration, constituting the most frequent alteration of the BM microenvironment. It is unclear to which extent modifications of the BM microenvironment, including in the context of osteoporosis, influence blood cell production. We aimed to describe the association between lumbar spine and total hip BMD and microarchitecture (assessed by trabecular bone score [TBS]) and differential blood counts. Data were collected at two time points from 803 (first assessment) and 901 (second assessment) postmenopausal women participating in the CoLaus/OsteoLaus cohort, a population‐based sample in Lausanne, Switzerland. Participants with other active disease or treatment that could influence hematopoiesis or osteoporosis were excluded. Bivariate and multivariate associations between each peripheral blood cell count and BMD or TBS were performed. Additionally, participants in the highest BMD and TBS tertiles were compared with participants in the lowest BMD and TBS tertiles. At first assessment, only neutrophils were significantly different in the lowest BMD and TBS tertile (3.18 ± 0.09 versus 3.47 ± 0.08 G/L, p = 0.028). At the second assessment, leucocytes (5.90 ± 0.11 versus 5.56 ± 0.10 G/L, p = 0.033), lymphocytes (1.87 ± 0.04 versus 1.72 ± 0.04 G/L p = 0.033), and monocytes (0.49 ± 0.01 versus 0.46 ± 0.1 G/L, p = 0.033) were significantly different. Power analysis did not identify quasi‐significant associations missed due to sample size. Although significant associations between blood counts and BMD or TBS were found, none was consistent across bone measurements or assessments. This study suggests that, at homeostasis and in postmenopausal women, there is no clinically significant association between the osteoporotic microenvironment and blood production output as measured by differential blood counts. In the context of conflicting reports on the relationship between osteoporosis and hematopoiesis, our study represents the first prospective two time‐point analysis of a large, homogenous cohort at steady state. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Abstract Background Femoral neck fractures (FNF) are frequent in the elderly population, and surgical management is indicated in the vast majority of cases. Osteosynthesis is an alternative to arthroplasty for non-displaced FNF. Triple screw construct (TS) and the dynamic hip screw system (DHS) are considered gold standards for osteosynthesis. The newly available femoral neck system (FNS) currently lacks evidence as to whether it is a valid alternative to TS and DHS. The purpose of this study was to evaluate the short-term clinical and radiological outcomes after non-displaced (Garden I and II) FNF osteosynthesis using TS, DHS, and FNS. Methods All the patients of the author’s institution aged ≥ 75 years with a non-displaced (Garden I and II) FNF eligible for osteosynthesis between November 2015 and December 2019 were included in this single-center retrospective non-randomized study. Patients were treated with either TS, DHS, or FNS depending on the surgeon’s preference. Clinical data (age, gender, ASA score, duration of surgery, need for blood transfusion and number of packed red blood cells transfused, surgical site complications, length of stay, discharge location, postoperative medical complications and readmission within 30 days, and mortality within 3 months) were extracted from the patients’ charts. The radiological analysis assessed the fracture classification, fracture impaction, and proximal femur shortening at 3 and 6 months using the institutional imaging software. Results Baseline characteristics in the TS (n = 32), DHS (n = 16), and FNS (n = 15) groups were similar with respect to age (mean 85 years), gender (female to male ratio 4:1), and ASA score. There were no significant differences across the groups for the need for blood transfusion, surgical site complications, length of stay, postoperative medical complications and readmission within 30 days, discharge location, and mortality within 3 months. The duration of surgery was significantly lower in the FNS group (43.3 vs 68.8 min; p < 0.001). The radiological assessment found similar impaction (5.2 mm ± 4.8) and shortening (8.6 mm ± 8.2) in all groups that did not seem to progress after 3 months. Conclusion The FNS appears to be a valid alternative implant for FNF osteosynthesis and is associated with a shorter operative time than TS and DHS. Short-term clinical and radiological outcomes of FNS are similar to TS and DHS implants. Further long-term multicenter randomized studies are however necessary to confirm these first results.

Background and purpose: The influence of postoperative limping on patient satisfaction and amount of limping reduction following THA are not well documented. We (1) assessed if postoperative limping is associated with satisfaction 5 years after THA performed via the lateral or anterior approach; (2) evaluated the influence of surgical approach on amount of limping reduction following THA. Patients and methods: We conducted a prospective cohort study of primary elective THAs performed in 2002–2013. Limping was assessed before and 5 years after surgery using the Harris Hip limping sub-score. Satisfaction was assessed at 5 years on a 5-point Likert scale. We compared proportions of satisfied patients among groups of limping. Evolution of limping before and after surgery was noted. Analyses were performed overall and stratified by pain and surgical approach. We used univariate and multivariate logbinomial regression models. Results: 1,257 patients were included (mean age 70 years). 81% had surgery via a lateral and 19% via an anterior approach. Before THA, 60% had moderate to severe limping and all reported pain. After THA, limping and pain improved; 9% of patients were dissatisfied. In multivariate analysis stratified on pain level, limping was associated with higher dissatisfaction. Similar results were obtained after lateral vs. anterior approach. Interpretation: Postoperative limping impacts patient satisfaction after THA. The association varied by degree of limping and absence or presence of pain. It was independent of surgical approach. 5 years after THA occurrence of limping was largely reduced after both a lateral and an anterior approach, with low evidence of a greater reduction under an anterior approach.

Abstract Background Ankle fractures are common, and their incidence has been increasing. Previous epidemiological studies have been conducted in the US, Scandinavia, and Scotland. Our objectives were to provide a current epidemiological overview of operatively treated ankle fractures and to evaluate the influence of age, sex, lifestyle factors, and comorbidities on fracture types. Methods We performed a population-based epidemiological study of all ankle fractures treated operatively in a 10- year period from 2002 to 2012. Results Two thousand forty-five ankle fractures were operated upon. Men and women differed significantly in age (median 41 vs. 57 years old), obesity (16% vs. 23%), diabetes (5% vs. 10%), smoking (45% vs. 24%), and accident type (daily activities 48% vs. 79%, transportation 24% vs. 9%, sports 21% vs. 8%) respectively. Overall, there were 2% Weber A, 77% Weber B, and 21% Weber C fractures; 54% were uni-, 25% bi-, and 21% trimalleolar; 7.5% of all fractures were open. Weber C fractures were much more frequent among men and with higher BMI (lowest vs. highest category: 14% vs. 32%), but slightly less frequent with older age and among current smokers. Trimalleolar fractures were twice as frequent in women and increased with age. Conclusion Men and women differed substantially in age, lifestyle factors, comorbidities, accident type, and type of ankle fracture. Male sex and higher BMI were more frequently associated with Weber C fractures, whereas female sex and older age were associated with trimalleolar fracture. The risk for severe fracture increased linearly with the degree of obesity.

Quantitative hazard analysis of rockfalls is a fundamental tool for sustainable risk management, even more so in places where the preservation of natural heritage and people’s safety must find the right balance. The first step consists in determining the magnitude-frequency relationship, which corresponds to the apparently simple question: how big and how often will a rockfall be detached from anywhere in the cliff? However, there is usually only scarce data on past activity from which to derive a quantitative answer. Methods are proposed to optimize the exploitation of multi-source inventories, introducing sampling extent as a main attribute for the analysis. This work explores the maximum possible synergy between data sources as different as traditional inventories of observed events and current remote sensing techniques. Both information sources may converge, providing complementary results in the magnitude-frequency relationship, taking advantage of each strength that overcomes the correspondent weakness. Results allow characterizing rockfall detachment hazardous conditions and reveal many of the underlying conditioning factors, which are analyzed in this paper. High variability of the hazard over time and space has been found, with strong dependencies on influential external factors. Therefore, it will be necessary to give the appropriate reading to the magnitude-frequency scenarios, depending on the application of risk management tools (e.g., hazard zoning, quantitative risk analysis, or actions that bring us closer to its forecast). In this sense, some criteria and proxies for hazard assessment are proposed in the paper.

Abstract Background Squeaking of ceramic-on-ceramic total hip arthroplasty is an unexpected complication which occurs in 1- 30% of patients. Revision surgery is required in 0.2% of the cases, when a ceramic fracture is suspected, or in case of severe malposition of the implants, subluxation, or impingement. Hip arthroscopy may be a useful diagnostic and therapeutic option in squeaking hips. Case presentation A patient presenting with a pain-free squeaking underwent hip arthroscopy to examine the sliding surfaces and the rim of the acetabulum, and to search for signs of impingement. Thorough lavage and debridement of hip synovitis and fibrous tissue was performed. The squeaking noise immediately disappeared after the surgery. The patient was allowed to fully weight bear as tolerated with 2 crutches for 2 weeks. Two years after the arthroscopy, the patient remained symptom-free. Conclusions The potential reasons for hip squeaking in our patient are discussed. Hip arthroscopy may prove useful as a diagnostic and therapeutic option for some patients presenting with a squeaking ceramic-on ceramic hip replacement.

Summary:. Several reconstructive approaches have been described for reconstruction after sacral chordomas, classically myocutaneous flaps. Recently, postural muscle preservation techniques are preferred whenever possible. We present the case of a 70-year-old man who underwent en-bloc resection of a sacral chordoma resulting in a large three-dimensional defect. To reconstruct the pelvic floor, an acellular dermal matrix and a double pedicled muscle gracilis flap were used to avoid herniation of the abdominal cavity organs. The overlying soft tissue defect was reconstructed with a unilateral gluteal fasciocutaneous rotation flap partially deepithelialized. No surgical complications were observed. Aesthetic and functional outcomes were both satisfying at 9-months postoperative follow-up. The ambulatory functions were not compromised. This combined flap reconstruction associated with a dermal matrix offers a reliable and effective option for sacral reconstruction while minimizing the morbidity.

Electro Fenton with volumic cathode consisting of granules of carbon graphite was applied to degrade the insecticide Isoprocarb in aqueous solutions. The effects of various factors including current intensity and pesticide initial concentration were investigated in order to obtain the best experimental conditions for its degradation and mineralization. Kinetic studies determined that the insecticide removal followed a pseudo first order. The absolute rate constant for the oxidation of Isoprocarb by hydroxyl radicals were determined as 3.32 × 109 L mol−1 s−1 by competitive kinetics method taking benzoic acid as reference compound. In this work, we have also studied the mineralization of aqueous solutions of this insecticide in term of total organic carbon (TOC). After 3 hours of electrolysis, and at I = 800 mA, more than 40 % of the organic carbon presented in the solution is mineralized. Various aromatic by-products, principally formed by oxidation of the pesticide, accompanied by hydroxylation of the aromatic cycle, have been identified. Thus, the oxidative opening of the aromatic ring leads to the formation of carboxylic acids and nitrate ions. The biodegradability of Isoprocarb is estimated by the measurement of its Biochemical Oxygen Demand (BOD5).

Abstract Background “Inflammaging” is a coined term that combines the processes of inflammation (within the normal range) and aging, since chronic, low-grade, systemic inflammation emerges with increasing age. Unlike high-level inflammation, with which deleterious effects on bone no longer need to be demonstrated, it is unclear whether inflammaging exerts deleterious effects on bone too. Method We assessed associations between inflammaging — measured via cytokine levels (high-sensitivity C-reactive protein (hs-CRP); interleukin-1β (IL-1β); interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)) — and bone parameters (prevalent and incident fractures, bone mineral density (BMD) and trabecular bone score (TBS)) in 1390 postmenopausal women from the OsteoLaus study. Results Mean (±SD) age was 64.5 ± 7.6 and mean bone mass index (BMI) 25.9 ± 4.5 kg/m2. Median hs-CRP, IL-1β, IL-6 and TNF-α were 1.4 pg/ml, 0.57 pg/ml, 2.36 pg/ml and 4.82 pg/ml, respectively. In total, 10.50% of the participants had a prevalent, low-impact fracture; and, after 5-years of follow up, 5.91% had an incident, low-impact fracture. Mean T-score BMD was − 1.09 ± 1.53 for the spine, − 1.08 ± 1.02 for the femoral neck, and − 0.72 ± 0.96 for the total hip. Mean spine TBS was 1.320 ± 0.10. We found a positive association between hs-CRP and BMD at all sites, and between hs-CRP and the TBS, but none of these associations were significant after adjustment. We found no association between prevalent or incident fractures and hs-CRP. No association was found between IL-1β, IL6 and TNF-α and BMD, TBS or fractures. Conclusion Our results suggest that bone imaging and structure parameters are not associated with the low-grade cytokine levels (within the normal range) observed with inflammaging.

The use of Nigella seeds in the food, pharmaceutical, and cosmetic fields is common, since the iniquity and the virtues of these plants are directly related to their characteristic phytochemical composition. This investigation focused on the comparative study of the botanical aspect, phenolic profile, and in vitro and in vivo biological activities of Nigella sativa L. (NS) and Nigella damascena L. (ND) seeds. The macro- and micro-morphological properties of these seeds were studied, and the key dissimilarities between them were clearly illustrated. The phytochemical contents and phenolic profiles were determined, and the in vitro antioxidant activity was assessed using four methods. The in vivo antioxidant and biochemical parameters of the blood of supplemented mice were determined. The results of the macro- and micro-structure analysis revealed differences between the two plants. Here, ND is characterized by higher phytochemical contents and the best antioxidant activities. The HPLC analysis indicated the presence of nine compounds, namely seven phenolic acids, particularly hydroxybenzoic and caffeic acids, and two flavonoids. The administration of ND extract to mice for 21 days at a concentration of 500 mg/kg allowed a substantial amelioration of plasma antioxidant properties. In addition, the extracts ameliorate blood parameters (cholesterol, triglycerides, glycemia, and urea). Furthermore, the antimicrobial activity of extracts demonstrated their effects on Staphylococcus and Aspergillus. Nigella seeds, in particular ND, expressed considerable in vitro antioxidant properties and demonstrated significant amelioration of mice blood properties. Consequently, these species can serve as a valuable source of compounds with various applications.

Abstract Introduction Quantitative in vivo measurement of brain amyloid burden is important for both research and clinical purposes. However, the existence of multiple imaging tracers presents challenges to the interpretation of such measurements. This study presents a direct comparison of Pittsburgh compound B–based and florbetapir‐based amyloid imaging in the same participants from two independent cohorts using a crossover design. Methods Pittsburgh compound B and florbetapir amyloid PET imaging data from three different cohorts were analyzed using previously established pipelines to obtain global amyloid burden measurements. These measurements were converted to the Centiloid scale to allow fair comparison between the two tracers. The mean and inter‐individual variability of the two tracers were compared using multivariate linear models both cross‐sectionally and longitudinally. Results Global amyloid burden measured using the two tracers were strongly correlated in both cohorts. However, higher variability was observed when florbetapir was used as the imaging tracer. The variability may be partially caused by white matter signal as partial volume correction reduces the variability and improves the correlations between the two tracers. Amyloid burden measured using both tracers was found to be in association with clinical and psychometric measurements. Longitudinal comparison of the two tracers was also performed in similar but separate cohorts whose baseline amyloid load was considered elevated (i.e., amyloid positive). No significant difference was detected in the average annualized rate of change measurements made with these two tracers. Discussion Although the amyloid burden measurements were quite similar using these two tracers as expected, difference was observable even after conversion into the Centiloid scale. Further investigation is warranted to identify optimal strategies to harmonize amyloid imaging data acquired using different tracers.

In regular times, implementing exercise-based injury prevention programs into the training routine of high-level and professional athletes represents a key and challenging aspect to decrease injury risk. Barriers to implementing such prevention programs have previously been identified such as lack of resources, logistic issues or motivation. The COVID-19 pandemic associated with restrictions on daily life dramatically impacted sports participation from training to competition. It is therefore reasonable to assume that such lockdown-like context has exacerbated the challenge to implement exercise-based injury prevention programs, potentially leading to a greater musculoskeletal injury risk. In this narrative review, recommendations are proposed for building an expertise- and evidence-based Standard Operating Procedure for injury prevention in lockdown-like contexts for high-level and professional athletes. The following recommendations can be provided: (1) assess the global and sport-specific risks in the light of the ongoing cause of isolation; (2) adapt remote training materials and programs; (3) ensure regular quality communication within the staff, between athletes and the staff as well as between athletes; (4) follow the athlete's mental well-being; and (5) plan for a safe return-to-sports as well as for an ongoing monitoring of the load-recovery balance. These key domains should further be addressed to comply with local policies, which are subject to change over time in each individual country. The use of these recommendations may improve the readiness of athletes, coaches, physicians and all sports stakeholders for future lockdown-like contexts.

Little is known regarding intuitive eating (IE), diet quality and adherence. We investigated the associations between IE, diet quality and metabolic health after gestational diabetes (GDM), who have an increased diabetes risk. Data from 179 women with GDM from MySweetheart trial (NCT02872974) were analyzed. IE was assessed using the eating for physical rather than emotional reasons (EPR) and reliance on hunger and satiety cues (RHSC) subscales of the French Intuitive Eating Scale-2. Metabolic outcomes included weight, central body fat and insulin resistance. Diet quality was calculated using the Alternative Health Eating Index (AHEI) and compliance with national recommendations was evaluated. Both IE subscales were associated with lower BMI and fat mass (BIA) at 1-year postpartum (all p ≤ 0.034). The EPR subscale inversely correlated with fat mass (DXA) and visceral adipose tissue (both p ≤ 0.028), whereas RHSC with higher insulin sensitivity (Matsuda, p = 0.034). RHSC during pregnancy predicted increased AHEI (p = 0.043) at 1-year postpartum, whilst EPR predicted lower fat mass and insulin resistance (HOMA-IR) (all p ≤ 0.04). In longitudinal analyses, both subscales were associated with increased adherence to dairy and fiber intake recommendations (both p ≤ 0.023). These data suggest IE may be an interesting approach to improve diet quality and metabolic outcomes in women with GDM.

Background: The preferred walking speed (PWS), also known as the “spontaneous” or “self-selected” walking speed, is the speed normally used during daily living activities and may represent an appropriate exercise intensity for weight reduction programs aiming to enhance a more negative energy balance. Objectives: The aim of this study was to examine, simultaneously, the energetics, mechanics, and perceived exertion determinants of PWS in individuals with obesity. Methods: Twenty-three adults with obesity (age 32.7 ± 6.8 years, body mass index 33.6 ± 2.6 kg/m2) were recruited. The participants performed 10 min of treadmill familiarization, and PWS was determined. Each subject performed six 5-min walking trials (PWS 0.56, 0.83, 1.11, 1.39, and 1.67 m/s). Gas exchanges were collected and analyzed to obtain the gross energy cost of walking (GCw), rated perceived exertion (RPE) was measured using a 6–20 Borg scale, and the external mechanical work (Wext) and the fraction of mechanical energy recovered by the pendular mechanism (Recovery) were computed using an instrumented treadmill. Second-order least-squares regression was used to calculate the optimal walking speed (OWS) of each variable. Results: No significant difference was found between PWS (1.28 ± 0.13 m/s) and OWS for GCw (1.28 ± 0.10 m/s), RPE cost of walking (1.38 ± 0.14 m/s), and Recovery (1.48 ± 0.27 m/s; p > 0.06 for all), but the PWS was significantly faster than the OWS for Wext (0.98 ± 0.56 m/s; p < 0.02). Multiple regression (r = 0.72; p = 0.003) showed that ∼52% of the variance in PWS was explained by Recovery, Wext, and height. Conclusion: The main finding of this study was that obese adults may select their PWS in function of several competing demands, since this speed simultaneously minimizes pendular energy transduction, energy cost, and perceived exertion during walking. Moreover, recovery of mechanical work, external work, and height seem to be the major determinants of PWS in these individuals.

Background and purpose — Data from several joint replacement registries suggest that the rate of early revision surgery after primary total hip arthroplasty (THA) is increasing. The ASA class, now widely recorded in arthroplasty registries, may predict early revision. We investigated the influence of ASA class on the risk of revision and other reoperation within 3 months and within 5 years of primary THA. Patients and methods — We used data from the Geneva and Swedish Hip Arthroplasty Registries, on primary elective THAs performed in 1996–2016 and 2008–2016, respectively. 5,319 and 122,241 THAs were included, respectively. Outcomes were all-cause revision and other reoperations evaluated using Kaplan–Meier survival and Cox regression analyses. Results — Within 3 months after surgery, higher ASA class was associated with greater risk of revision and other reoperation. 3-month cumulative incidences of revision by ASA class I, II, and III–IV respectively, were 0.6%, 0.7%, and 2.3% in Geneva and 0.5%, 0.8%, and 1.6% in Sweden. 3-month cumulative incidences of other reoperation were 0.4%, 0.7%, and 0.9% in Geneva and 0.2%, 0.4%, and 0.7% in Sweden. Adjusted hazard ratios (ASA III–IV vs. I) for revision within 3 months were 2.7 (95% CI 1.2–5.9) in Geneva and 3.3 (CI 2.6–4.0) in Sweden. Interpretation — Assessment of ASA class of patients prior to THA will facilitate risk stratification. Targeted risk-reduction strategies may be appropriate during the very early postoperative period for patients identified as at higher risk. Systematically recording ASA class in arthroplasty registries will permit risk adjustment and facilitate comparison of revision rates internationally.

BACKGROUND:Patients with endogenous hypercortisolism have reduced bone mineral density (BMD) and trabecular bone score (TBS) that are the causes of secondary osteoporosis and low-traumatic fractures. It is well known that radical treatment (neurosurgery or radiosurgery) of Cushings disease leads to a decline of cortisol levels in all body fluids to normal values. However, it is still uncertain whether bone tissue structure, and particularly its microarchitecture, does recover in remission of the disease. AIMS:To evaluate an influence of hormone activity (presence or absence of remission) in patients with Cushing's disease on changes of bone structure measurements in accordance with DXA values (TBS, BMD, T- and Z-scores), as well as significance of such changes in 12 and 24 months after neurosurgical treatment. MATERIALS AND METHODS:In patients with confirmed active Cushing's disease (ACTH-producing pituitary adenoma) (n = 44) and in control group of healthy volunteers (n = 40), BMD in lumbar spine (L1-L4) and simultaneously TBS, in cut-off points before neurosurgical treatment (in both groups) and in 12 and 24 months after it (only in patients), were assessed. We diagnosed presence or absence of disease remission at cut-offs. All measurements were performed using a GE iDXA device (GE Healthcare Lunar, Madison, Wisconsin, USA). The TBS was calculated simultaneously from taken BMD scans, blinded to clinical outcome using TBS iNsight software v2.1 (Medimaps, Merignac, France). The activity of Cushings disease was evaluated using late-night salivary cortisol (LNSC, at 23:00). To determine the differences in DXA and TBS values before and after neurosurgical intervention depending on remission occurrence, covariate analysis (ANCOVA) was applied. RESULTS:There were found significant changes in TBS, BMD and T-score values in 12 months after neurosurgical treatment associated with presence or absence of disease remission (p = 0.039, 0.046 and 0.048, respectively). No differences in Z-score as well as in all measurements in 24 months, that might be associated with remission occurrence, were revealed. The gain in all DXA measurements (including TBS) during 24 months of observation period was statistically significant when analyzing data using Students paired t-test. However, the values corresponding to the age references had not been achieved for the specified time interval. CONCLUSIONS:Patients with Cushings disease have lower TBS values. In remission conditions TBS is getting significantly higher. The increase in BMD and TBS occurs during 24 months after achieving remission of Cushings disease but doesnt lead to a full restoration of normal bone mass and microstructure throughout observation period of 24 months.

Six to eight months after total hip arthroplasty, patients only attain 80% of the functional level of control groups. Understanding which functional tasks are most affected could help reduce this deficit by guiding rehabilitation towards them. The timed up-and-go test bundles multiple tasks together in one test and is a good indicator of a patient's overall level of function. Previously, biomechanical analysis of its phases was used to identify specific functional deficits in pathological populations. To the best of our knowledge, this analysis has never been performed in patients who have undergone total hip arthroplasty. Seventy-one total hip arthroplasty patients performed an instrumented timed up-and-go test in a gait laboratory before and six months after surgery; fifty-two controls performed it only once. Biomechanical features were selected to analyse the test's four phases (sit-to-stand, walking, turning, turn-to-sit) and mean differences between groups were evaluated for each phase. On average, six months after surgery, patients' overall test time rose to 80% of the mean of the control group. The walking phase was revealed as the main deficiency before and after surgery (-41 ± 47% and -22 ± 32% slower, respectively). High standard deviations indicated that variability between patients was high. On average, patients showed improved results in every phase of the timed up-and-go test six months after surgery, but residual deficits in function differed between those phases. This simple test could be appropriate for quantifying patient-specific deficits in function and hence guiding and monitoring post-operative rehabilitation in clinical settings.

Acetabular peri-prosthetic fractures are rare but their incidence is rising due to the increased prevalence of total hip arthroplasty, the increasing life expectancy and the growing functional demand of an ageing population, the incidence of primary total hip arthroplasty is increasing. They are either intra-operative or post-operative and have various aetiologies. Several factors such as implant stability, bone loss, remaining bone stock, fracture pattern, timing, age and co-morbidities of the patients must be considered for adequate treatment. To date, the literature on this subject has been sparse and no universally recognized treatment algorithm exists. Their rarity makes them a little-known entity and their surgical management represents a challenge for most orthopaedic surgeons. This review aims to present an update on epidemiology, the diagnostic work up, existing classification systems, surgical approaches and therapeutic options for acetabular peri-prosthetic fractures.

Nitrous oxide (N2O) is a greenhouse gas difficult to estimate by satellite because of its weak spectral signature in the infra-red band and its low variability in the troposphere. Nevertheless, this study presents the evaluation of new tropospheric N2O observations from the Infrared Atmospheric Sounder Interferometer (IASI) on Metop-A using the Toulouse N2O Retrieval Version 2.0 tool. This tool is based on the Radiative Transfer for Tiros Operational Vertical sounder (RTTOV) model version 12.3 coupled to the Levenberg-Marquardt optimal estimation method enabling the simultaneous retrieval of methane, water vapour, temperature profiles together with surface temperature and emissivity within the 1240–1350 cm−1 window. In this study, we focused on the upper troposphere (300 hPa) where the sensitivity of IASI is significant. The IASI N2O data has been evaluated using aircraft N2O observations from the High-performance Instrumented Airborne Platform for Environmental Research Pole-to-Pole Observations (HIPPO) campaigns in 2009, 2010, and 2011 and from the National Oceanic and Atmospheric Administration’s (NOAA) Global Greenhouse Gas Reference Network (GGGRN) in 2011. In addition, we evaluated the IASI N2O using ground-based N2O measurements from 9 stations belonging to the Network for the Detection of Atmospheric Composition Change (NDACC). We found a total random error of ∼2 ppbv (0.6%) for one single retrieval at 300 hPa. Under favorable conditions, this error is also found in the vertical level pressure range 300–500 hPa. It decreases rapidly to ∼0.4 ppbv (0.1%) when we average on a 1° × 1° box. In addition, independent observations allows the estimation of bias with the IASI TN2OR v2.0 N2O. The bias between IASI and aircraft N2O data at 300 hPa is ∼1.0 ppbv (∼0.3%). We found an estimated random error of ∼2.3 ppbv (∼0.75%). This study also shows relatively high correlations between IASI data and aircraft in situ profiles but more varying correlations over the year 2011 depending on the location between IASI and NDACC remote sensing data. Finally, we present daily, monthly, and seasonal IASI N2O horizontal distributions in the upper troposphere as well as cross sections for different seasons that exhibit maxima in the Tropical band especially over Africa and South America.

Summary: Lockdown measures are essential to containing the spread of coronavirus disease 2019 (COVID-19), but they will slow down economic growth by reducing industrial and commercial activities. However, the benefits of activity control from containing the pandemic have not been examined and assessed. Here we use daily carbon dioxide (CO2) emission reduction in China estimated from statistical data for energy consumption and satellite data for nitrogen dioxide (NO2) measured by the Ozone Monitoring Instrument (OMI) as an indicator for reduced activities consecutive to a lockdown. We perform a correlation analysis to show that a 1% day−1 decrease in the rate of COVID-19 cases is associated with a reduction in daily CO2 emissions of 0.22% ± 0.02% using statistical data for energy consumption relative to emissions without COVID-19, or 0.20% ± 0.02% using satellite data for atmospheric column NO2. We estimate that swift action in China is effective in limiting the number of COVID-19 cases

BACKGROUND This report describes a new strategy for the care of patients with osteogenesis imperfecta, based on an interdisciplinary team working. Thereby, we aim at fulfilling three main goals: offering thorough coordinated management for all, and improving physical activity and quality of life of the patients. AIM With rare diseases such as osteogenesis imperfecta (OI), patients and their family often suffer from inadequate recognition of their disease, poor care coordination and incomplete information. A coordinated interdisciplinary approach is one possible solution for providing both comprehensive and cost-effective care, with benefits for patient satisfaction. Poor physical activity and impaired quality of life represent a considerable burden for these patients. To better address these issues, in 2012 we created an interdisciplinary team for the management of OI patients in our University Hospital Centre (CHUV, Lausanne University Hospital,). In this article we describe the implementation of this interdisciplinary care strategy for patients suffering from OI, and its impact on their physical activity and quality of life. METHODS All patients from the French part of Switzerland were invited to join us. We proposed two complementary evaluations: the initial interdisciplinary evaluation and a yearly follow-up during a special day – the “OI day”. This day features specialised medical appointments adapted to each patient’s needs, as well as lectures and/or workshops dedicated to patients’ and families’ education. Our first aim was to propose for each patient the same management, from diagnosis to the bone health evaluation and physical therapy advice. Our second aim was to evaluate the evolution of physical activity, quality of life (measured by EQ-5D, SF-36 and a dedicated questionnaire) and satisfaction of patients and their families. Here we report both the initial and the long-term results. RESULTS Since 2012, 50 patients from the French part of Switzerland received the personalised medical evaluation. All of the patients included in this study had the same initial evaluation and at least one participation in an OI Day. All patients had an adaptation of their bone acting drugs. Over a 7-year period, 62% of inactive patients started some physical activity, and 44% of patients who were not involved in any athletic activity started participating in sports. The mean EQ-5D increased from 0.73 to 0.75 (p = 0.59). The mean physical SF36 (musculoskeletal function) score was 59.09 ± 22.72 and improved to 65.79 ± 21.51 (p = 0.08), whereas it was 68.06 ± 20.05 for the mental SF36 without alteration during follow-up. The OI day was revealed to be useful, it contributed to improvement in continuity of care and helped families to better understand the OI patients’ health. CONCLUSIONS Our interdisciplinary approach aimed at offering the same thorough management for all patients from the French part of Switzerland, and at improving both the physical activity and the satisfaction of the patients and their family. This report is a basis for future work focusing on the effect of bone fragility and the impact of OI on patients’ social relations.