Telomeres, located at the ends of each chromosome play a vital role in determining cellular fate and aging. Accelerated shortening of telomeres may also result in accelerated aging and occurrence of age-related degenerative diseases. Anti-aging treatments may help in increasing the telomere length along with improving quality of life, reducing dependency for daily life activities, increasing life expectancy and reducing the risks associated with aging. In this study, we evaluated the effect of anti-aging integrative therapy in 36 individuals. The treatment included a combination of HBOT, ozone therapy, colon hydrotherapy, etc. Telomere length was used as a biomarker for objectively quantifying the outcome of the treatment. The effect of treatment was also assessed on various aging symptoms. At the end of the treatment, it was found that that 97.22% individuals showed an increase in telomere length with an average increase of 0.43 Kbp and 94.44% individuals showed reduced biological age with an average decrease of 3.8 years. These improvements were statistically significant. Improvements were also recorded in the majority of the symptoms. No major adverse events were observed. These results indicate that antiaging integrative therapy has the potential to reverse aging symptoms, cellular aging and improve quality of life.

Background/Objectives:The first attempts of posterior lumbar interbody fusion can be traced back to the 1940s, where their performance was marked by animosity due to high rates of failure. Nowadays, the use of interbody fusion involves a much more complicated consideration of factors such as global alignment, disc height, fusion rates, and operative risk, all combined at once.Our study aims to examine all these effects using Flarehawk 9 as a means of interbody fusion.Materials and methods: A total of 58 patients underwent open posterior lumbar surgery using Flarehawk 9 between September 2021 and February 2023 with a mean follow up of 1 year.The mean age was 59.8 years old ( range between 33 and 79 years old), 36 of them are males while 22 of them are females. The diagnostic groups included spinal canal stenosis (n=40), failed back surgery syndrome-revision surgery (n=5),spondylolisthesis with slip percentage 25% (n=4),recurrent herniated disc (n=7) and adjacent segment disease (n=2). Results: The majority of patients demonstrated remarkable improvement based on ODI scores.The rate of union varied based on the fused levels and whether the patients had previous surgery or not.The amount of lordosis postoperatively is increased by 2±0.4 degrees.Conclusions: Even though anterior approaches become more and more popular and advanced nowadays, posterior fusion with interbody cage still remains a safe and effective method to treat various spine surgical pathologies with optimal results.

In patients with primary central nervous system lymphoma (PCNSL), the choice of surgical strategy for histopathologic assessment is still controversial, particularly in terms of preoperative corticosteroid (CS) therapy. To provide further evidence for clinical decision-making, we retrospectively analyzed data from 148 consecutive patients who underwent surgery at our institution. Although patients treated with corticosteroids preoperatively were significantly more likely to require a second or third biopsy (p=0.049), it was only necessary in less than 10% of the cases with preoperative corticosteroid treatment. The choice of surgical procedure did not affect diagnostic accuracy (p>0.05). Preoperative CSF sampling did not provide additional information but was associated with delayed surgery (p=0.02). Surprisingly, diagnostic accuracy was significantly lower when patients were treated with anticoagulation or dual antiplatelet therapy (p=0.015). In conclusion, preoperative CS therapy can challenge the histological diagnosis of PCNSL. At the same time, our data suggest that preoperative CS treatment only presents a relative contraindication for an early surgical intervention. The standard surgical approach is stereotactic biopsy, but other approaches can be individually considered. If a definitive diagnosis cannot be made after the first surgical intervention, the timing of a repeat biopsy after discontinuation of CS remains a case-by-case decision.

As exemplified by the global response to the SARS-CoV-2 pandemic, whole genome sequencing played an important role in monitoring the evolution of novel viral variants and provided guidance on potential antiviral treatments. The recent rapid and extensive introduction and spread of highly pathogenic avian influenza virus in Europe, North America and elsewhere raises the need for similarly rapid sequencing to aid in appropriate response and mitigation activities. To facilitate this objective, we investigated a next generation sequencing platform that uses a portable nanopore sequencing device to generate and present data in real time. This platform offers the potential to extend in-house sequencing capacities to laboratories that may otherwise lack resources to adopt sequencing technologies requiring large benchtop instruments. We evaluated this platform for routine use in a diagnostic laboratory. In this study we evaluated different primer sets for the whole genome amplification of influenza A virus and evaluated five different library preparation approaches for sequencing on the nanopore platform using the MinION flow-cell. A limited amplification procedure and a rapid procedure were found to be best among the approaches taken.

Total hip arthroplasty (THA) is a preferred treatment for primary osteoarthritis (OA) or secondary due to developmental hip dysplasia (DDH). Gait analysis is considered a golden standard for evaluating post-arthroplasty walking patterns. This study compared post-THA spatiotemporal gait parameters (SGPs) between OA and DDH patients and explored correlations with demographic and clinical variables. Thirty patients (15 per group) were recorded during gait, and their SGPs were analyzed. Functionality was evaluated with the Oxford Hip Score (OHS). The OA patients were significantly older than DDH (pr< 0.51, all p< 0.05). The preoperative gait alterations associated with OA or DDH were improved to similar levels in both groups after THA. Post-arthroplasty SGPs and OHS correlations indicate limitations in certain activities. These find-ings must be correlated with kinetic gait analysis data to fully evaluate gait and functionality dif-ferences among patient groups.

With an increase in proportion of elderly patients, the global burden of spinal disease is on the rise. Likewise, there has been an increasing trend in the number of spine surgeries being performed worldwide. As we know, rehabilitation following spine surgery is critical for optimal recovery. However, current literature lacks consensus regarding the appropriate post operative rehabilitation protocol. The goals of rehabilitation after lumbar spine surgery are to improve physical and psychosocial function and may include multiple modalities such as physical therapy, cognitive behavioral therapy, specialized instruments, and instruction to be followed during activities of daily living. In recent years, not only are a greater number of spine surgeries being performed, various different techniques of lumbar spine surgery and spinal fusion have emerged. Physical therapy programs need to be curated after assessing the functional status of the patient by using various patient reported outcome measures and taking into consideration the technique of spinal fusion used and the muscle groups involved in these surgeries. By doing so it is possible to assess the level of functional impairment and then specifically target strengthening of those muscle groups affected by surgery whilst also improving impaired balance and allowing return to activities of daily living. We reviewed available literature pertaining to the history of spinal rehabilitation, the popular patient reported outcome measures used and different rehabilitation methods with the purpose of summarizing the current guidelines for postoperative rehabilitation after spine surgery and to introduce the rehabilitation after lumbar surgeries that we provide at our hospital.

We investigated the micro-threaded stem taper surface and the impact on premature failures, aseptic loosening, and infection. We have focused on the fretting, and crevice corrosion of micro-threaded tapers, as well as the characterization of microstructure and surface properties of two new and three retrieved Zweymüller stem tapers of cementless hip endoprostheses selected from a set of 45 stems. The retrievals examined were those in which the sole source of modularity with a metallic component was the head-stem taper interface between the Ti alloy taper stem and the ceramic head. To determine the surface chemistry and microstructures of both new and retrieved hip endoprostheses stem taper titanium alloy, scanning electron microscopy (SEM) was employed for morphological and microstructural analyses. At the same time, energy dispersive spectroscopy (EDS) was utilized for characterizing chemical element distribution, and electron backscattered diffraction (EBSD) was used for phase analysis. The micro-threated stem taper’s roughness for different manufacturers was investigated using an optical profilometer. Standard roughness pa-rameters Ra (average surface roughness) and Rz (mean peak to valley height of the roughness pro-file) were used in this investigation.Additionally, profile depth and peak spacing for different samples were investigated. The surface roughness results indicate no significant difference in roughness associated with varying survivorship times, ranging from 3 to 239 months, and across different manufacturers. Electrochemical studies revealed no fretting corrosion in retrieved stem tapers (ceramic head) that prematurely failed due to aseptic loosening after 239 months, infection after 3 months, and low-grade infection after a 32-month lifetime. Therefore, three retrieved ta-pers and two new ones for comparison underwent potentiodynamic measurements in Hank’s so-lution to ascertain the corrosion rate of new and retrieved stem taper surfaces. The results show a low corrosion rate for both new and retrieved samples that failed prematurely due to aseptic loosening. However, the corrosion rate of infected and low-grade infected tapers was higher. In conclusion, our study aligns with existing literature, suggesting that the use of ceramic heads de-creases the problem of taper corrosion and subsequently reduces premature failures in total hip arthroplasty.

Abstract: Spinal disorders are some of the most prevalent health concerns, especially among stu-dents. Based on student demographics, this cross-sectional study evaluated the correlation be-tween functional tests (FT) and spinal range of motion (ROM). This study included 206 students from Vasile Alecsandri University of Bacău. Participants' assessments were conducted using the following tests: (i) Ott, (ii) Schober, (iii) Stibor, (iv) finger-to-floor distance, (v) lateral flexion of the cervical and lumbar spine, and (vi) flexion of the cervical spine. Correlation analyses were evaluated using Spearman correlation coefficient analysis. The results indicated a very strong re-lationship between lateral flexion of the lumbar spine on the left (LFLSL) and right (LFSR) for all departments (r = 0.85 to 0.97, p < 0.05). There was a stronger relationship between FT results and spinal ROM of physical education department students compared to students from other de-partments (n = 17, r = -0.38 to 0.93, p < 0.05). There was no statistically significant correlation be-tween FT and spinal ROM based on age (p > 0.05). The study results provide evidence of the pri-mary risk factors that predispose students to postural deviations. Practitioners and physiothera-pists can utilize these values as a reference for potential therapeutic interventions.

The aging of the population in developing and developed countries has lead to a significant increase in health burden of spinal diseases. These elderly patients often have a number of medical co-morbidities due to aging. The need for minimally invasive techniques to address spinal disorders in this elderly population group cannot be stressed enough. Minimally invasive spine surgery (MISS) has several proven benefits such as minimal muscle trauma, minimal bony resection, lesser post-operative pain, decreased infection rate and shorter hospital stay. Over the last 40 years, constant efforts are being made to develop newer techniques of spine surgery. Endoscopic spine surgery is one such subset of MISS which has all the benefits of modern MISS. Endoscopic spine surgery initially was limited only to treatment of lumbar disc herniations. With improvement in optics, endoscopes, endoscopic drills and shavers, irrigation pumps, there has been a paradigm shift. Endoscopic spine surgery can now be performed with high magnification thus allowing its application not only to lumbar spinal stenosis, but also to spinal fusion surgeries, cervical and thoracic pathology as well. There has been increasing evidence in support of these newer techniques of spine surgery. For the purpose of this review, we studied current available literature and outlined the historical evolution of endoscopic spine surgery, the various different endoscopic systems, and techniques available and the current applications of endoscopic techniques as an alternative to traditional spinal surgery.

Introduction:Lumbar radiculopathy, frequently triggered by disc herniation, affects around one in 50 young adults (30-55 ages), leading to significant impacts on quality of life. When conservative treatments fail to alleviate symptoms, surgical intervention such as discectomy is often pursued. Technological advancements have led to various minimally invasive techniques, promising improved outcomes. Our aim was to compare clinical outcomes of different techniques.Methods:We conducted a systematic search in PubMed using "lumbar disc hernia" and the meta-analysis filter. Inclusion criteria comprised meta-analyses focusing on lumbar disc herniation treatments, published in English. A rigorous selection process adhering to PRISMA guidelines ensured high-quality evidence extraction.Results:From 28,171 initial records, 31 meta-analyses involving 87,852 patients were included. Heterogeneity across the literature presented challenges, notably in study populations, surgical techniques, and research designs. Among the techniques evaluated, full-endoscopic lumbar discectomy (FELD) emerged as superior in various perioperative parameters, including Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI), operation time, and complications. Conversely, automated percutaneous discectomy (AUTD) consistently exhibited poorer outcomes, suggesting limited effectiveness compared to other techniques. Conclusion:Despite advancements, the heterogeneity observed in the literature underscores the need for standardized approaches in minimally invasive spinal surgery research. FELD stands out as a preferred technique, offering favorable outcomes across multiple parameters. Conversely, techniques like AUTD raise concerns regarding efficacy. Future research should aim for uniformity in methodologies to facilitate accurate comparisons and guide clinical decision-making.

Objectives Independent validation of risk scores after hip fracture is uncommon, particularly for evaluation of outcomes other than death. We aimed to assess the Nottingham Hip Fracture Score (NHFS) for prediction of mortality, physical function, length of stay and postoperative complications. Design Analysis of routinely collected prospective data partly collected by follow-up interviews. Setting and Participants Consecutive hip fracture patients were identified from the Northumbria hip fracture database between 2014-2018. Patients were excluded if they were not surgically managed or if scores for predictive variables were missing. Methods C-statistics were calculated to test the discriminant ability of the NHFS, Abbreviated Mental Test Score (AMTS), and ASA grade for in-hospital, 30- and 120-day mortality, functional independence at discharge, 30-days and 120-days, length of stay, and postoperative complications. Results We analysed data from 3208 individuals, mean age 82.6 (SD 8.6). 2192 (70.9%) were female. 194 (6.3%) died during the first 30-days, 1686 (54.5%) were discharged to their own home, 211 (6.8%) had no mobility at 120-days, 141 (4.6%) experienced a postoperative complication. The median length of stay was 18 days (IQR 8-28). For mortality, c-statistics for the NHFS ranged from 0.68-0.69, similar to ASA and AMTS. For postoperative mobility, the c-statistics for the NHFS ranged from 0.74-0.83, similar to AMTS (0.61-0.82) and better than the ASA grade (0.68-0.71). Length of stay was significantly correlated with each score (p<0.001 by Jonckheere-Terpstra test); NHFS and AMTS showed inverted U-shaped relationships with length of stay. For postoperative complications, c-statistics for NHFS (0.54-0.59) were similar to ASA grade (0.53-0.61) and AMTS (0.50-0.58). Conclusions and Implications The NHFS performed consistently well in predicting functional outcomes, moderately in predicting mortality, but less well in predicting length of stay and complications. There remains room for improvement by adding further predictors such as measures of physical performance in future analyses.

There are no studies that have investigated the characteristics of car use across THA patients, including those who do not drive. This study aimed to evaluate, in THA patients, (1) postoperative car usage, (2) comfort while entering and exiting a car, and (3) whether lower limb muscle strength affects action comfort. One hundred seventy-two post-THA patients completed the questionnaire in 2020, along with assessments of hip abductor and knee extensor muscle strength before surgery and at discharge. Patients whose overall comfort level was judged as “comfortable” were defined as the “comfort” group; others were placed in the “discomfort” group. Of the 172 patients, 161 reported car usage at a mean of 5.6 years after THA. Of these, 114 and 47 patients were placed in the "comfort" and "discomfort" groups, respectively. Patients in the "discomfort" group were three times more likely to experience discomfort using the contralateral side door than the surgical side door, and about twice as many patients experienced discomfort when entering as when exiting. Lower preoperative contralateral hip abductor muscle strength was the only independent predictor for discomfort. The take-home messages were that prevention of contralateral-side weakness may improve comfort during the action after THA.

Hip joint surgeries, including total hip replacement or resurfacing, have increased tremendously in the last decades. Number of patients of all ages, replace their hip, due to severe injuries or trauma problems, so as to have a better life. According to these factors, new material and processes in implants manufacturing are imported to medicine, through research programs, every year. In the scope of one of these programs, that has to do with ceramic coatings on metallic resurfacing implants, a new 3axis Hip simulator was designed and manufactured in the Laboratory of Manufacturing Technology of the National Technical University of Athens. The scope of this paper is to present the main parts, materials and process used to manufacture the simulator as well as the way the simulator is working and how its movement in 3axis is accomplished. Furthermore, the evaluation of the machine and its use to examine resurfacing implants is presented.

Background and Objectives: Intramedullary spinal cord tumors (IMSCT) are rare entities. Especially, a location in the upper cervical spine as a highly eloquent region carries the risk of postoperative neurological deficits, such as tetraparesis or respiratory dysfunction. Evidence for respiratory dysfunction is scarce. The aim of this study was to describe the early and late postoperative clinical course of this highly eloquent tumours. Patients and Methods: This is a single-centre retrospective cohort study. We included 35 patients with IMSCT at levels of craniocervical junction to C4 who underwent surgical treatment between January 2008 and December 2022. The authors analysed the patients' preoperative status, tumour- and surgery-specific characteristics, and follow-up functional status. Results: The study cohort included 22 patients with grade II ependymoma (62.9%), 2 low-grade astrocytomas (5.7%), 2 glioblastomas (5.7%), 6 hemangioblastomas (17.1%), 2 metastases (5.7%), and 1 patient with partially intramedullary schwannoma (2.9%). Gross total resection was achieved in 76% of patients. Early dorsal column related symptoms and motor deterioration occurred in 64% and 44% of patients, respectively. At a follow-up of 3.27 ± 3.83 years, 43% and 33% of patients preserved postoperative sensory and motor deterioration, respectively. The median McCormick Scale grade was 2 in the preoperative and late postoperative periods, respectively (p=0.0897, α=0.05). Only two out of 35 patients (5.7%) developed new intermittent respiratory dysfunction, of whom two were transient. There were no surgery-related deaths. Conclusions: The surgery of IMSCT of the upper cervical spine could be performed without major procedure-related risk. Roughly a half of the patients develop new neurological deficit in the immediate postoperative period. However, most of the patients still maintain functional independence. The rate of respiratory insufficiency is low and is strongly influenced by the rapid neurological deterioration in high-grade tumours.

Introduction Delayed intra-operative neuro-monitoring (IOM) events can be defined as loss of responses, after baseline traces were present upon completion of instrumentation and deformity correction. This study reports this subgroup of events, assesses their incidence and evaluates potential causative factors. Methods We reviewed 1881 consecutive patients who underwent spinal deformity correction between 2011 and 2021. Surgeries were performed using a standardised anaesthetic regimen and multimodal IOM protocol. Results 44 patients (2.4%) had an IOM event. 9 patients (6F:3M) had a true positive delayed event after posterior segmental pedicle screw instrumentation. Mean age was 12.5 (2-17) years with mean thoracic Cobb angle of 78° (51-94°). Mean estimated blood loss was 28%. Titanium beam shaped rods were utilised in 3 patients and 5.5mm titanium rods in 5 patients. Motor evoked potentials were lost on average 18 (10-30) minutes after completion of instrumentation. 7 patients had bilateral loss and 2 patients had unilateral loss of MEP traces. Sensory evoked potential amplitude was preserved in all cases. There was a transient latency shift in one patient. MEPs returned within 20 minutes of rod release. The rod was re-contoured to incorporate more scoliosis in 1 patient. 2 patients had beam rods exchanged to 5.5mm titanium rods. 6 patients had rod removal with retention of pedicle screws and staged completion of instrumentation at mean 5 (1-7) days later. No patients had a postoperative neurological deficit. Conclusion Delayed IOM loss represented 15% of all events. Increased cord tension and hypo-perfusion were considered likely mechanisms. Rod release restored MEPs in all cases. The timing of events emphasises the importance of continued monitoring for minimum 30 minutes after completion of spinal instrumentation or until wound closure.

Despite ongoing efforts, the relationship between groin strength and injury remains unclear. The challenge of accurately predicting injuries presents an opportunity for researchers to develop pre-vention strategies to reduce the occurrence of such injuries. Consequently, this issue requires further investigation to obtain insights into effective mitigation strategies. In 120 male soccer players the maximum isometric strength of the hip muscle groups was measured, and the strength ratios were calculated. Previous injury and anthropometric data were registered. Injury data were collected following the FIFA/UEFA consensus. The K- Nearest Neighbour (k-NN), was used to predict the incidence of injury, while the significant predictive variables of the k-NN algorithm were fitted into a multivariate logistic regression model (LR) to analyze the likelihood of players sustaining a groin injury. The LR model determined two variables as significant predictors of groin injury. Players were less likely to sustain a groin injury by 76% for each decrease of the Adductors/Abductors isometric strength ratio in the non-dominant limb (OR = 0.238, CI 95%= [(0.098-0.572]). Players with a history of previous injury had a 67% greater risk of sustaining an injury (OR = 0.333, CI 95%= [(0.1068-1.038]). Isometric hip adductor and abductor strength im-balances of the non-dominant lower limb and a history of previous injury were risk factors for groin injury in soccer players.

Performance of the overhead squat may affect golf swing mechanics associated with golf-related low back pain. This study investigates the difference in lumbar kinematics and joint loads during the golf downswing between golfers with different overhead squat abilities. Based on the per-formance of the overhead squat test, 21 golfers aged 18 to 30 years were divided into the highest-scoring group (HS, N=10, 1.61 ± 0.05 cm, and 68.06 ± 13.67 kg) and lowest-scoring group (LS, N=11, 1.68 ± 0.10 cm, and 75.00 ± 14.37 kg). Data collection used a motion analysis system, two force plates, and TrackMan. OpenSim software was used to simulate the joint loads for each lum-bar joint. An independent t-test was used for statistical analysis. Compared to golfers demonstrat-ing limitations in the overhead squat test, golfers with better performance in the overhead squat test demonstrated significantly greater angular extension displacement on the sagittal plane, smaller lumbar extension angular velocity, and smaller L4-S1 joint shear force. Consequently, the overhead squat test is found to be a useful index to reflect lumbar kinematics and joint loading patterns during the downswing, and provides a good training guide reference for reducing the risk of a golf-related low back injury

Total hip arthroplasty is a complex procedure. The achievements of implantology enabled the development of a faithful representation of hip joint physiology as well as the production of materials that can successfully replace damaged natural tissues. A very important issue is the correct selection of the geometry of the endoprosthesis adequate to the load of the joint. Materials used for endoprosthesis are a metal head and a polymer cup (e.g. PE-UHMW). The main interactions in the endoprosthesis are friction and surface pressure, which must be limited, exceeding them causes the destruction of the biomechanical system - plastic deformation of the polymer and the formation of too large and unacceptable radial clearances. Based on the author's developed calculation method of hip joint endoprosthesis contact parameters, the impact on maximum contact pressure and the angle of contact of the joint load was estimated depending on the diameter of the endoprosthesis and radial clearance. The correctness of changing the values of maximum contact pressure from the mentioned parameters was determined. Correspondingly: an increase in joint load causes a linear increase in the maximum contact pressure; increasing the diameter of the endoprosthesis head - their non-linear decrease, and increasing radial clearance - their increase

Dendritic spines are essential for synaptic function because they constitute the neurons' postsynaptic compartment that receives the most excitatory input. The extracellularly shorter variant of the presynaptic cell adhesion molecules neurexins, β-neurexins, has been implicated in various aspects of synapse function including neurotransmitter release. However, its role in developing or stabilizing dendritic spines as fundamental computational units of excitatory synapses remained unclear. Here, we show by morphological analysis that the deletion of β-neurexins in hippocampal neurons in vitro and in hippocampal tissue in vivo affects presynaptic dense-core vesicles and, unexpectedly, postsynaptic spine structure. Specifically, we observed that the absence of β-neurexins led to an increase in longer spinous protrusions in vitro and more mature mushroom-type spines in the CA1 region of adult knockout mice. In addition, deletion of β-neurexins caused alterations in spine head dimension and more spines with perforations of their postsynaptic density but no change in the overall number of spines or synapses. Our results indicate that presynaptic β-neurexins play a role across the synaptic cleft, possibly by aligning with postsynaptic binding partners and glutamate receptors via transsynaptic columns.

Introduction: Subtalar Arthroereisis (STA) is a surgical intervention for pediatric flexible flatfoot (PFF), primarily targeting hindfoot alignment by limiting excessive subtalar eversion. However, its effects on forefoot parameters remain underexplored. This study aims to investigate radiological changes following STA in pediatric patients. Materials and Methods: A retrospective analysis was conducted on consecutive patients treated with STA for PFF. First ray-related angles, including Hallux Valgus Angle (HVA) and Inter-Metatarsal Angle (IMA), alongside hindfoot radiological parameters such as Meary, Calcaneal Pitch, and Costa Bartani angles, were assessed. Subgroup analysis by gender was performed, and correlations between demographic and pre-operative radiological parameters were examined. Results: Forty-one patients (81 feet) with a mean age of 11.6 years were included, with a mean follow-up duration of 6.4 months. No significant differences were observed in first ray-related an-gles pre- and post-operatively, with mean IMA changing from 7.97° to 7.18° and mean HV angles from 9.51° to 8.66°. Noteworthy improvements were seen in flat foot angles, including Meary, Calcaneal Pitch, and Costa Bartani angles, postoperatively. Age subgroup analysis revealed similar trends in IMA and HVA changes between Group A (operated before peak growth) and Group B (operated later). Higher preoperative angles tended to improve, while lower preoperative IMA and HVA tended to worsen postoperatively, all remaining within normal ranges. Conclusion: STA showed positive radiological outcomes for PFF treatment, while negligible changes in first ray-related angles were observed. Age subgroup analysis indicated similar trends regardless of operation timing. Higher preoperative angles tended to improve, while lower preoperative angles tended to worsen postoperatively, despite all falling within non-pathological ranges. Further re-search is warranted to confirm this correlation.

Osteoarthritis (OA) poses a growing challenge for the aging population, especially in hip and knee joints, contributing significantly to disability and societal costs. Conventional clinical evaluations, typically performed in controlled settings, face difficulties in capturing the dynamic characteristics of rehabilitation and functioning in real-life scenarios. The study assessed the use of automated unsupervised evaluations in the rehabilitation process for patients after hip and knee replacements. We analyzed data from 1144 individuals who used a digital application after surgery, activity data were collected using the Garmin Vivofit 4. Several parameters such as the Peak 6-Minute Consecutive Cadence (P6MC) and Peak 1-Minute Cadence (P1M) were computed and analyzed on a daily basis. The results indicated that cadence measurements, specifically, can effectively differ among individuals with hip and knee conditions as well as the recovery process. Moreover, these metrics demonstrated a high level of responsiveness in monitoring the progress of recovery, surpassing the effectiveness of simply measuring the total number of steps taken. The study highlighted the capacity of technology-driven, patient-centered rehabilitation to improve accuracy, tailor therapy to individual patients, and increased patient involvement. This research also highlighted the significance of automated, unsupervised assessments in enhancing rehabilitation results for OA patients following hip and knee replacement, as tele-rehabilitation becomes increasingly important.

The ultrasound guided viscosupplementation of the hip joint with hyaluronic acid(HA)is considered a standard procedure among the conservative treatments for hip arthritis.The aim of the study was to evaluate the clinical benefit and the incidence of adverse events of the technique in a obseravtional study at one year follow up. We evaluated a consecutive series of 85 patients with a diagnosis of symptomatic arthritis that performed intra-articular ultrasound-guided hyaluronic acid injections. The scales used for evaluation were modified Harris Hip Score(mHHS),WOMAC (Western Ontario and McMaster University),Hip Outcome Score (HOOS) with subscale Sport (HOOSs), for pain the Visual Analogic Scale (VAS).The patients were classified according to Tonnis’ radiological classification of arthrosis (range 0-3):20 patients(grade 0),32(grade 1),18(grade 2),15(grade 3).At last follow up all the scales increased:mHHS from 59.35 to 82.1,HOOS from 69.45 to 78.53,HOS Sport from 47.4 to 58.11,VAS from 6.09 to 3.97,WOMAC from 33.2 to 31.5 (p<0.05 for all the parameters);13/85 requested arthroplasty. Based on our findings, indication for use of hyaluronic acid is limited to patients with mild to moderate arthritis.Patients in advanced arthritis refusing replacement surgery and asking for this treatment should be informed about the poor results of the technique even in the short term follow up.

Owing to the risk of atypical femoral fractures, total hip arthroplasty presents unique challenges for patients with ipsilateral osteoarthritis and localized periosteal thickening in the femoral subtrochanteric region. Stem length selection is critical for minimizing stress concentration in the thickened cortex to avoid such fractures. Herein, we report the case of a 78-year-old woman with ipsilateral hip osteoarthritis and localized subtrochanteric periosteal thickening. Preoperative planning included finite element analysis to assess stress distribution across various stem lengths. Simulation aimed to determine the optimal stem length to span the cortical thickening and reduce the risk of postoperative complications. The results of finite element analysis indicated that a stem length of &gt;150 mm was required to effectively reduce the stress at the site of cortical thickening. A 175-mm stem was selected for total hip arthroplasty, which provided a favorable stress distribution and avoided the risk of stress concentration. Therefore, in cases of ipsilateral osteoarthritis with localized subtrochanteric periosteal thickening, finite element analysis can be valuable for preoperative planning to determine the optimal stem length, thereby reducing the risk of atypical femoral fractures. Further studies with multiple cases are recommended to validate these findings and improve surgical outcomes.

Spinal deformity refers to a range of disorders that are defined by anomalous curvature of the spine and may be classified as scoliosis, lordosis, or kyphosis. Among these, scoliosis stands out as the most common type of spinal deformity in human beings, and it can be distinguished by abnormal lateral spine curvature accompanied by axial rotation. Accurate identification of spinal deformity is crucial for a person's diagnosis, and numerous assessment methods have been developed by researchers. Therefore, the present study aims to systematically review recent works on spinal deformity as-assessment for scoliosis diagnosis, utilizing image processing techniques. To gather relevant studies, a search strategy was conducted on three electronic databases (Scopus, ScienceDirect, and PubMed) between 2012 and 2022, using specific keywords and focusing on scoliosis cases. A total of 17 papers fully satisfied the established criteria and were extensively evaluated. Despite variations in methodological designs across the studies, all reviewed articles obtained quality ratings higher than satisfactory. Various diagnostic approaches have been employed, including artificial intelligence mechanisms, image processing, and scoliosis diagnosis systems. These approaches have the potential to save time and, more significantly, can reduce the incidence of human error. While all assessment methods have potential in scoliosis diagnosis, they possess several limitations that can be ameliorated in forthcoming studies. Therefore, the findings of this study may serve as guidelines for the development of a more accurate spinal deformity assessment method that can aid medical personnel in the real diagnosis of scoliosis.

Antibiotic-loaded bone cement has been traditionally advocated as a key step for the success of one-stage hip revision surgery, while cementless techniques have been recently proposed with and without the use of local antibacterials as an equally successful alternative. Aim of this review is to investigate the effective role of local antimicrobial protection for one-stage cemented and cementless hip revision surgery. Twelve studies reporting the results of cemented single-stage procedure at a minimum two years follow-up were reviewed. When pooling together the data, no infection recurrence was observed on average in 83.3% of the patients (range 75.0% to 100%). Only two papers, both from the same French group, included patients treated without the use of antibiotic-loaded bone cement, with an average infection control of 95.9% in a total of 195 patients. This figure appears better that the 80.7% infection control obtained by pooling together all the remaining studies. Concerning cementless one-stage revision, a total of 17 studies, reporting on 521 patients, showed an average 90.0% (range 56.8% to 100%) no infection recurrence, at a minimum two years follow-up. Eight papers reported the outcomes of cementless implants without any local antibacterial protection and nine more described four different techniques for local antimicrobial implant protection. No comparative study investigated cementless revision with or without local antibacterial protection. Pooled data showed an average infection control of 86.7%, without the application of local antibacterials, compared to 90.1% to 100% with local antimicrobial protection, depending on the technology used. However, due to the relatively low number of patients treated with each local antimicrobial protection, no statistical difference could be found, either considering local antibacterial strategies alone or pooled together. No side effect had been reported by any local antibacterial technique. This review points out that local antibacterial protection for one-stage hip revision surgery, although safe and largely performed in the clinical setting, appears still to rely mainly on experts’ opinion and on observational series with no prospective or comparative trial, hence no definitive conclusion can be drawn concerning its effective role in one-stage hip revision surgery.

Background: developmental dysplasia of the hip (DDH) is a condition characterized by abnormal hip development in infancy. Early diagnosis allows for effective treatment, while late presentation often necessitates complex surgical interventions. Current recommendations advise screening between the 6th and 8th week postnatal using ultrasound, typically employing the Graf method. However, there's no universal consensus on whether ultrasound screening significantly increases treatment compared to clinical examination-guided ultrasound. This study aims to explore the feasibility of prenatal ultrasound for early identification of DDH risk. Methods: This prospective observational study involved 100 pregnant women undergoing fetal hip ultrasound during the second and third trimesters. Using the modified Graf method, alpha and beta angles were calculated on the fetus. Postnatally, alpha and beta angles were compared with prenatal values. Results: Prenatal ultrasound at 24th week showed inconclusive results because of the difficulty in identification of Graf landmarks, while ultrasound at 34th week has proved to be a reliable and safe method for quantitative determination of alpha and beta angles. Significant correlations were found between prenatal and postnatal alpha and beta angles. Moreover, significant differences in prenatal alpha and beta values were observed in patients developing mature/immature hips postnatally. Conclusions: Prenatal diagnostics show promise for predicting infant hip development. Further research is warranted to validate correlation strength and clinical applicability.

Background: The incidence of fracture and surgery of the hip and lower extremities is still high. Long postoperative bed rest has the potential to increase the incidence of various complications that may increase the morbidity and mortality rate of patients after hip and lower extremities surgery. Aim: This literature review aimed to identify the effects of early mobilization in hip and lower extremity postoperative. Method: Search for articles on several databases such as ProQuest, ScienceDirect, CINAHL, Medline, Wiley Online and Scopus, using the Boolean operator by combining several keywords according to the literature review topic, with inclusion criteria are published in the last 3 years (2019-2021), used a quantitative design, written in English and full text articles. A total of 435 articles were obtained, then screened and reviewed, so that there were 16 (sixteen) eligible articles.Result: There were 11 (eleven) effects of early mobilization, i.e. reducing length of stay, reducing the risk of deep vein thrombosis (DVT), reducing pulmonary infections (pneumonia), reducing urinary tract infections, reducing the risk of wound infection, improving extremity function and ability to walk, reducing postoperative pain, reducing the risk of pressure sores, reducing postoperative delirium, reducing readmission and lowering hospitalization costs. Conclusion: This literature review showed that early mobilization is safe and effective in postoperative patients to reduce the risk of complications and adverse events. Nurses and health workers who care for patients could implement early mobilization and motivate patients to be cooperative in undergoing early mobilization.

Background: Post-operative delirium in elderly with hip fracture is associated with various adverse clinical outcomes. Nevertheless, the pathophysiological processes underpinning delirium have remained elusive. The aim of this study is to explore the associations between delirium and its features and immune-inflammatory and blood gas biomarkers.Methods: In this prospective study we examined 65 patients who underwent a hip fracture surgery and assessed the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), Richmond Agitation-Sedation Scale (RASS), and Delirium Rating Scale Revised-98 (DRS-R-98) before and during 4 days after the surgery. Complete Blood Count (CBC) and venous blood gas markers were obtained at the same time points.Results: Delirium was observed in 19 patients and was accompanied by significantly increased pO2, number of white blood cells, neutrophil percentage, and neutrophil/lymphocyte ratio, and lower mean platelet volume (MPV) (after adjusting for age, central nervous system (CNS) disease, blood loss during surgery, sleep disorders, and body mass index. The severity of delirium was associated with lowered number of platelets and MPV. Psychomotor disorders were associated with lower bicarbonate levels. The requirement of physical restraint of the patients was predicted by increased percentages of neutrophils and lymphocytes. Prior CNS disease was together with these biomarkers a significant predictor of delirium and severity of delirium. Conclusion: Delirium and psychomotor disorders following hip fracture and surgery may be caused by immune-inflammatory and oxidative stress pathways probably attributable to an aseptic inflammatory process. Oxygen administration may aggravate these pathways.

Background: Facial features are the first basic spring of medical knowledge in children and adults with congenital malformation. Children born with multiple contractures almost always receive the misdiagnosis of arthrogryposis multiplex. Larsen syndrome can easily be diagnosed at birth via the proper interpretations of its characteristic facial features and multiple dislocations. Instant diagnosis can facilitate the orthopaedic strategy for early treatment and follow-ups. Material and Methods: Six children (four boys and two girls, age range from a few months to 7 year-old) have been referred to our departments for diagnosis and treatment. All children received their first misdiagnosis by the paediatricians as having arthrogryposis multiplex congenita. The clinical phenotype was our first decisive tool for diagnosis. All children exhibited the classical phenotype of Larsen syndrome, dish-like facies associated with multiple joint dislocations. Radiological phenotypic characteristics confirmed our clinical diagnosis. three children out of six showed unpleasant cervical spine deformities. The first child of a-2- year old became tetraplegic after minor trauma. One child presented with rigid cervical kyphosis. The third child wasa product of first related marriage and was born congenital tetraplegia. genotype has been carried out for confirmation. Results: Three children underwent open reduction for congenital hip and knee dislocations. one child underwent spinal fusion CO-C7 because of tetraplegia. 3D reformatted and reconstruction CT scan of the craniocervical junction in two children showed unusual male segmentations along C2-3 causing effectively the development of rigid cervical kyphosis and one child with congenital tetraplegia showed serious malsegmentation of C1/C2 associated with hypoplasia of the anterior and the posterior rings of the atlas. These findings in the last two children made any surgical intervention quite sophisticated. Four of these children were compatible with the autosomal dominant type of Larsen syndrome and manifested heterozygous mutation in FLNB mapped 3p14.3, encoding and actin-binding protein, filamin B. One child showed no mutations in the FLNB, though his clinical and radiological phenotype and his family history of first related marriage were totally compatible within the diagnosis of autosomal recessive type of Larsen syndrome. Conclusion: The orthopaedic strategy in patients with Larsen syndrome can not be achieved unless a precise diagnosis is has to be established as early as possible. Arthrogryposis multiplex congenita has been the first false diagnosis which was the reason for improper management.The most diagnostic confusion /error occurs to the paediatricians is the multiple contractures which are akin to arthrogryposis multiplex congenita. In practice, arthrogryposis multiplex congenita is a symptom complex rather than a precise diagnostic entity. The second diagnostic misconception is the generalized ligamentous hyperlaxity which can mimic hypotonia. Hypotonia in a newborn can be falsely categorized within the floppy infant syndrome. We used 3D reformatted CT scan to further understand the craniocervical junction pathology in three children with cervical spine kyphosis. Strikingly, mal segmentation and defective ossifications of the atlanto-axial spine segments in a child with Larsen syndrome and congenital tetraplegia.

Abstract: Background: The main aim of the study was to assess the intensity and frequency of cervical spine pain in young people with temporomandibular disorders (TMD). Methods: The pilot study was conducted from June to July 2023. Inclusion criteria were: age (18-30 years), cervical spine pain (for at least 1 month) and consent to participate in the study. The study was conducted based on a physiotherapeutic examination and an original questionnaire. The pain level was assessed using the Visual Analogue Scale (VAS). Among 95 people with cervical spine pain, 51 people (53.7%) constituted the control group (without a history of temporomandibular disorders), while 44 (46.3%) people constituted the study group. Results: The mean age of people participating in the study was 22.2±2.2 years in the study group and 22.5±3.1 years in the control group. The largest group were people aged 21-25 (n=51 people, 53.7%). Patients from the study group more often experienced pain in the stomatognathic system during palpation (both in the muscle, joint and musculoskeletal groups) and had reduced mobility of the temporomandibular joints in every movement (p<0.001). People from the study group were characterized by also less mobility of the cervical spine (p<0.05), apart from extension movement (p>0.05). There was a significant relationship between temporomandibular disorders and cervical spine pain (p<0.05, chi2=10.118, df=1, rc=0.31). The level of back pain was significantly higher in people from the study group (p<0.001, chi2=45.765, df=4, rc=0.57). Conclusions: Our research has shown that the causes of cervical spine pain at a young age may be temporomandibular disorders, which are generally not recognized and properly treated.

Transitional vertebra has been reported along of the spine in many researches focused especially on carnivores. The current study had the objectives to identify the presence of transitional lumbosacral and sacrocaudal vertebra in domestic mammals, to realize a comparative analysis of the localization and conformation of this abnormal condition. For this purpose the researches included animals belonging to next species: cow – 29 specimens, sheep – 32 specimens, horse – 31 specimens, pig – 26 specimens, rabbit – 33 specimens, dog – 89 specimens and cat – 57 specimens. The most of the animals, respectively their spine were analysed post mortem, after the dissection performed in the anatomy laboratory, except the dogs and 48 cats that were examined radiologically. The investigations revealed the presence of transitional vertebra in all species as follow: in cows – 3 cases (8,7%), all being about the lumbarization of first sacral vertebra (S1); in sheep – 3 cases (9,37%), two lumbarization cases of S1 and one caudalisation of S4 (the last sacral vertebra); in horses – 4 cases (12,9%), all about the sacralisation of Cd1 (first caudal vertebra); in pigs – 3 cases (11,53%), two lumbarisation cases of S1 and one sacralisation of Cd1; in rabbits – 3 cases (9,09%), a lumbar supernumerary vertebra (L8) and two cases of caudalisation of S4; in dogs – 4 cases (4,49%), a lumbar supernumerary vertebra (L8) and 3 cases of sacralisation of last lumbar vertebra (L7 or L8); in cats – 3 cases (5,26%), two sacralisation cases of last lumbar vertebra and one caudalisation of last sacral vertebra (S3). A strong lumbarization process was observed in ruminants (especially in cows), then in pigs, the sacralisation being prevalent in carnivores. The sacrocaudal transitional vertebrae was predominant in horses, but occurred as an ossification process especially in old animals.

Aging is associated with muscle atrophy and fatty infiltration of skeletal muscle. The multifidus muscle stabilizes the lumbar spine and undergoes adipose accumulation with age, leading to functional decline in the elderly. Therefore, quantitative assessment of the multifidus muscle can be beneficial for the elderly when formulating treatment strategies and reducing future complications. Fifty-seven patients (mean age, 73.89 ± 6.09; 23 male patients) who underwent lumbar Magnetic resonance imaging (MRI) were prospectively recruited. The cross-sectional area (CSA) of the multifidus from the L2-S1 level and the CSA of the L4-5 level psoas muscle were measured. The functional CSA (fCSA) of the multifidus muscle was measured by excluding the fat infiltration area from the multifidus CSA. The CSA to fCSA ratio was obtained by multiplying 100 by the value obtained by dividing CSA by the fCSA. Pfrrmann classification was used to evaluate the degree of disc degeneration. The functional disability measurements were the Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), grip strength, and functional reach test (FRT). Pearson's correlation analysis was used to examine the relationship between the functional disability measurements and the multifidus muscle. The CSA to fCSA ratio value was relatively constant at each spine level and showed a significant correlation with the SPPB, grip strength, FRT, and psoas index (p&lt;0.05). However, degree of disc and multifidus muscle degeneration were not statistically significant. So, age-related changes play a significant role in developing back muscle fatty infiltration than disc dgeneration. Moreover, Grip strength showed a stronger relationship with the quality of the multifidus muscle than other functional disability measurements.

Nature provides plenty of good examples for simple and very efficient joint assemblies. One example is the enormously flexible cervical spine of American barn owls, which consists of 14 cervical vertebrae. Each pair of vertebrae produces a comparatively small individual movement in order to provide a large overall movement of the entire cervical spine. The biomimetic replication of such joints is difficult due to the delicate and geometric unrestricted joint shapes as well as the muscles that have to be mimicked. Using X-ray as well as micro computed tomography images and with the utilisation of additive manufacturing, it is possible to produce the owl neck vertebrae in scaled-up form, to analyse them and then to transfer them into technically usable joint assemblies. The muscle substitution of these joints is realised by smart materials actuators in the form of shape memory alloy wire actuators. This actuator technology is outstanding for its muscle-like movement and for its enormous energy density [1,2]. The disadvantage of this wire actuator technology is the low rate of contraction, which means that a large length of wire has to be installed to generate adequate movement. For this reason, the actuator wires are integrated into additively manufactured carrier components to mimic the biological joints. This results in joint designs that compensate for the disadvantages of the small contraction of the actuators by intelligently installing large wire lengths on comparatively small installation spaces, while also providing a sufficient force output. With the help of a test rig, the developed technical joint variants are examined and evaluated. This demonstrates the technical applicability of this bionic joints.

The EXO+ hip protector was developed to minimize the risk of hip fractures in seniors following falls. This study evaluated its usability in a Singapore nursing home from the perspective of staff, focusing on Learnability, Efficiency, and Satisfaction. A mixed-method design was employed, with nursing home residents wearing the EXO+ daily for 8 weeks. Quantitative data on wear time was collected alongside qualitative insights from four repeated focus group discussions with care staff. In total, 15 residents (including 8 residents with cognitive impairments) and 9 staff participated. The analysis revealed six themes and fourteen subthemes related to EXO+’s usability. Residents wore the device for an average of 1.54 hours per day, with those having cognitive impairments showing increased wear times, especially in the mornings and on weekdays. Findings indicated that the EXO+ was learnable and satisfactory for nursing home use, provided there are adequate supporting features. The efficiency of the EXO+ was not fully measured since no falls were reported during the study period. The study offers valuable insights for potential design modifications and workflow adaptations to enhance the implementation of hip protectors in healthcare settings, highlighting facilitators and barriers to support device uptake.

There are several challenges on how to attain energy efficiency while maintaining balance among factors affecting energy consumption such as power rating and temperature setpoints of cooling units, room temperature and humidity, and indoor air quality (IAQ). A real-time energy and IAQ monitoring system were installed in an educational building to profile the operational power consumption of inverter-based air condition unit (ACU) installed in each room. Polynomial curve and neural fitting regression analysis were applied to the real-time power consumption, indoor temperature and humidity, and carbon dioxide (CO2) level data. The derived models were able to provide the stabilizing indoor thermal and air conditions of the room to reach steady state ACU power consumption. These collected data and calculated parameters can be used to define rules in automating control of cooling appliances for an efficient energy utilization. The regression approaches, using real-time data, have determined the influence of indoor heat conditions and carbon dioxide levels on ACU power consumption. These parameters were utilized to establish consistent values for temperature, humidity, and carbon dioxide levels under stable settings of inverter-based air conditioning units.

Music has been proposed for a long time as a treatment for mental disorders. However, some special types of music or stimulating sounds might induce negative emotions. Herein, 8-week-old male mice were exposed to two specific genres of music, hip-hop (HH) and heavy metal (HM), and construction noise (CN), and a series of behavioral experiments were performed to evaluate the impact of these music or sounds on the emotion of mice. The experiment lasted 1 week in which 8-week-old male mice were used as animal models. We found that long term exposure HM, HH, and CN induced depressive symptoms with a decrease in dopamine receptor 1 and BDNF in the mixture of hippocampus and frontal cortex of mice. Our results have highly addressed that certain special types of sound or music might induce negative emotions and loss of dopaminergic neurons in mice, and it is necessary to intervene in adolescences who are exposed to these music or sounds for a long time.

This study evaluated the hip joints of the giant anteater (Myrmecophaga tridactyla) through imaging and macroscopic analyses and proposed a surgical approach for arthrotomy procedures in this species. The study used four samples fixed in 10% formaldehyde and six thawed carcasses. Radiographic and ultrasound examinations and anatomical dissection allowed the proposal of a surgical approach for the hip joint. The radiographic evaluation occurred with frog-legged ventrodorsal and lateral projections, and the ultrasound enabled joint soft tissue assessment. The articular elements represented similar characteristics to other domestic species. Some anatomical particularities of muscle groups were the intermuscular septum between the tensor fasciae latae and superficial gluteus muscles at the level of the greater trochanter of the femur, which provides lateral access to the femoral head and neck more conservatively. In conclusion, the anatomical particularities of radiographic positioning, the clinical applications of joint ultrasound, and the arrangement of muscle groups must be considered when evaluating and surgically accessing the hip joint of the giant anteater.

Background and Objectives:: Hip osteoarthritis is the main cause physical disability, also has a serious impact on the efficiency and independence of older people. The aim of the study was to analyze the relationship between hip osteoarthritis and the risk of sarcopenia. Our main hypothesis was whether the risk of sarcopenia, as measured by the SARC F questionnaire , is related to the physical fitness of older people with hip osteoarthritis. Materials and Methods: The study was conducted with the participation of 177 people of aged 65 or more, diagnosed hip osteoarthritis. The subjects were assessed using the SARC F questionnaire, the Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG) test. The subjects were divided into two groups depending on the result they obtained in the SARC F questionnaire (group 1- SARC F &lt;4, group 2 - SARC F ≥ 4). Results: There was a significant correlation between the results in the SARC F and the results of the TUG (p&lt;0.001) and the SPPB test, both the SPPB total score (p&lt;0.001)and its elements: SBBP chair stand test (p&lt;0.001), SPPB balance test (p&lt;0.001), SPPB gait speed test (p&lt;0.001). Logistic regression of the SPPB and TUG predictors showed that in SARC F more than 4 predicted worse SPPB and TUG outcomes. In the SARC group, F above 4 increases the odds of poorer scores in SPPB OR=1.097; CI 95% 1.053-1.146 and TUG, OR=1.096; CI 95% 1.104-1.266. Conclusion: The study showed that the results obtained in the SARC F questionnaire correlate with the possibilities of physical functioning in patients with hip osteoarthritis SARC F is an inexpensive method that can be used to assess the risk of sarcopenia. Healthcare professionals, especially in primary care, should consider assessing the risk of sarcopenia especially in people with hip osteoarthritis.

There are several causes of hypoxia during and after surgery, and atelectasis is a common symptom that occurs during surgery. In particular, elderly patients are more vulnerable to hypoxia due to their existing lung diseases or respiratory muscle weakness. This study presents the cases of two elderly patients who developed hypoxia during total hip arthroplasty under general anesthesia. Positive end expiratory pressure, recruitment maneuver, and increased fraction of inspired oxygen improved hypoxia only temporarily, and patients’ oxygen saturation level again dropped to 79%–80%. We suspected that hypoxia was caused by atelectasis and, therefore, re-sumed spontaneous respiration. Thereafter, both the patients showed an improvement in hypoxia. Intraopera-tive hypoxia that is suspected to be caused by atelectasis can be improved by securing sufficient lung volume for respiration through increased muscle tone with spontaneous respiration

We have previously shown that the transmembrane protein ODZ1 promotes cytoskeletal remodelling of glioblastoma (GBM) cells and invasion of the surrounding parenchyma through activation of a RhoA-ROCK pathway. We also described that GBM cells can control the expression of ODZ1 through transcriptional mechanisms triggered by binding of IL-6 to its receptor and a hypoxic environment. Epidermal growth factor (EGF) plays a key role in the invasive capacity of GBM. However, the molecular mechanisms that enable tumor cells to acquire the morphological changes to migrate out from the tumor core have not been fully characterized. Here we show that EGF is able to induce the expression of ODZ1 in primary GBM cells. We analysed the levels of EGF receptor (EGFR) in 20 GBM primary cell lines and found expression in 19 of them by flow cytometry. We selected two cell lines that do or do not express EGFR and found that EGFR-expressing cells responded to EGF ligand by increasing ODZ1 at the mRNA and protein level. Moreover, blockade of EGF-EGFR binding by Cetuximab, inhibition of the p38 MAPK pathway or siRNA-mediated knockdown of MAPK11 (p38 MAPK) reduced the induction of ODZ1 in response to EGF. Overall, we show that EGF may activate an EGFR-mediated signalling pathway through p38 MAPK, to upregulate the invasion factor ODZ1, which may initiate morphological changes for tumor cells to invade the surrounding parenchyma. These data identify a new candidate of the EGF-EGFR pathway for novel therapeutic approaches.

While some research supports utilizing plain radiography for measuring biomechanical alignment of the spine for prognosis and treatment, there are contrasting viewpoints regarding both the value and utilization of these procedures in conservative care. Evaluation of both conservative and non-conservative approaches to spinal care revealed vast differences in radiographic utilization and interpretation between orthopedic surgeons, primary care physicians, chiropractic physicians, and physical therapists, which may account for the different viewpoints and rationale in the literature. A research summary is provided regarding the various methods of spinal analysis utilized by these professions to help determine if there is any unique diagnostic or prognostic value associated with radiographic utilization that could assist in advancing conservative spinal assessment and treatment. Understanding any unique value provided through biomechanical assessment utilizing plain radiography of the spine established in the literature may help chiropractic physicians determine the appropriate use of radiographic procedures in clinical practice and how to coordinate efforts with other conservative and non-conservative professions to improve spinal healthcare.

Background: Surgical decompression (SD) with and without posterior stabilization followed by radiotherapy is an established treatment for patients with metastatic spinal disease with epidural spinal cord compression (ESCC). This study aims to identify risk factors for occurrence of neurologic comprise resulting from local recurrence. Methods: All patients who received surgical treatment for metastatic spinal disease at our center between 2011 and 2022 were included in this study. Cases were evaluated for tumor entity, surgical technique for decompression (decompression, hemilaminectomy, laminectomy, corpectomy) neurological deficits, grade of ESCC, time interval to radiotherapy and perioperative complications. Results: A total of 747 patients were included in the final analysis, with a follow-up of 296.8 days (95% CI (263.5, 330.1)). During the follow-up period 7.5% of patients developed spinal cord/cauda syndrome (SCS). Multivariate analysis revealed prolonged time (&gt; 35 d) to radiation therapy as solitary risk factor (p &lt; 0.001) for occurrence of SCS during follow-up. Conclusion: Surgical treatment of spinal metastatic disease improves patients’ quality of life and Frankel grade but radiation therapy needs to be scheduled within a time frame of few weeks in order to reduce the risk of tumor-induced neurologic comprise.

Osteoporosis is a common problem in orthopedic medicine, and it has become an important medical issue in orthopedics as Taiwan is gradually becoming an aging society. In the diagnosis of osteoporosis, the bone mineral density (BMD) derived from dual-energy X-ray absorptiometry (DXA) is the main criterion for orthopedic diagnosis of osteoporosis, but due to the high cost of this equipment and the lower penetration rate of the equipment compared to the X-ray images, the problem of osteoporosis has not been effectively solved for many people who suffer from osteoporosis, however, at present, in clinical diagnosis, doctors are not yet able to accurately interpret X-ray images for osteoporosis manually, and must rely on the data obtained from DXA. In recent years, with the continuous development of artificial intelligence, especially in machine learning and deep learning, significant progress has been made in image recognition. Therefore, it is worthwhile to revisit whether it is possible to use a convolutional neural network model to read a hip X-ray image and then predict the patient's BMD. In this study, we proposed a hip X-ray image segmentation model and a hip X-ray image recognition classification model. First, we used the U-Net model as a framework to segment the femoral neck, greater trochanter, wards triangle, and the total hip in the hip X-ray images. We then performed image matting and data augmentation. Finally, we constructed a predictive model for osteoporosis using deep learning algorithms. In the segmentation experiments, we used intersection over union (IoU) as the evaluation metric for image segmentation, and both the U-Net and U-Net++ models achieved segmentation results greater than or equal to 0.5. In the classification experiments, using the T-score as the classification basis, the total hip using the DenseNet121 model has the highest accuracy of 74%.

Robotic-assisted hip and knee arthroplasty represents significant advancements in orthopedic surgery. Artificial intelligence (AI) - driven chatbots, such ChatGP, plays a significant role in healthcare education. This study aims to evaluate the quality of responses provided by ChatGPT to the top 20 questions concerning robotic-assisted hip and knee arthroplasty.We have asked ChatGPT to select the top 20 questions on Google concerning robotic hip and knee arthroplasty and to provide a detailed answer to each of them. The accuracy of the information provided were examined by three orthopedic surgeons with scientific and clinical experience in hip and knee replacement surgery. The accuracy was assessed through a 5-point Likert scale (from 1 – completely incorrect to 5 – correct); the completeness through a 4-point Likert scale (from 0 – comprehensiveness not assessable for completely incorrect answers to 3 – exhaustive information) on two different occasions to ensure the consistency of the assessment. Our analysis reveals that ChatGPT provides a relatively high degree of accuracy, moreover the explanations can be considered satisfy, especially for factual questions. The findings suggest that ChatGPT can serve as a valuable initial resource for general information on robotic hip and knee arthroplasty but the integration with human expertise remains essential.

The purpose of this case study was to evaluate the benefits that evidence-based nutritional and training recommendations could have on the time course of reconditioning following hip arthroplasty in a competitive master triathlete. Methods: During 38 weeks (from 6 weeks prior to surgery through to the return to competition), the athlete was provided with detailed training and nutritional recommendations based on the latest research evidence. Dietary intake (via the remote food photographic method), body composition (via DXA), peak oxygen uptake (VO2peak), peak power output (PPO) and cycling efficiency (GE) were assessed 6 weeks pre- and 8, 12, 18, 21 and 25-weeks post-surgery. Training load was quantified (TRIMP score) daily during the retraining. Results: Total body mass increased by 8.2 kg (attributable to a 3.5 and 4.6 kg increase in fat mass and lean mass, respectively) between week -6 and week 8 despite a reduction in carbohydrate (CHO) intake post-surgery (<3.0g/kg/day). This was accompanied with a decrease in VO2peak, PPO, and GE due to a drop in training load. From week 7, the athlete resumed training and was advised to gradually increase CHO intake according to the demands of training. Conclusions: Eventually the athlete was able to return to competition in week 32 with a higher PPO, improved VO2peak and GE. Throughout retraining, energy availability was maintained around 30 kcal/kg LBM/day, protein intake was high while CHO intake was periodised. Such dietary conditions allowed the athlete to maintain and even increase lean mass, which represents a major challenge with ageing.

Background: Despite the tremendous effort in hamstring injury prevention, injury rates in soccer remain elevated. Hypothesis: Hamstring and hip/pelvic isometric strength imbalances may increase the likelihood of hamstring strain injury (HSI) occurrence amongst soccer players.Study design: Case-control study.Methods: In 120 male soccer players (mean age: 20.0 +/- 6.96 years) pre-season maximum isometric strength of the hip adductors, abductors, flexors, and knee flexors were measured, and strength ratios were calculated. Previous injury and anthropometric data were registered. Injury data were collected following the FIFA/UEFA consensus. A multivariate and Machine learning-based Logistic Regression model was employed to estimate the likelihood of players sustaining a hamstring injury.Results: 21 players sustained 32 hamstring injuries. Players with higher abduction strength in the dominant leg had an 18.5% lower risk of sustaining a hamstring injury (OR = 0.818, CI 95% = [(0.695-0.964]). No other significant contributor variables were found to be significant predictors of hamstring injury in the player group (p> 0.05).Conclusion: Isometric strength of the abductor muscles in the dominant limb had a significant association with hamstring injury.Clinical relevance: Our findings indicate the utilization of hip strength measurements as an integral component of the pre-season screening assessment, thereby affirming prior research on the correlation between lumbo-pelvic stability and incidence of hamstring injuries. Consequently, clinicians should contemplate incorporating hip strengthening exercises into regular training sessions, rehabilitation programs, and injury prevention protocols especially indicated when lower hip strength levels are observed.

This contribution attempts to provide a state-of-the-art account on the physicochemical and biomedical properties of plasma-sprayed hydroxylapatite (HAp) coatings that are routinely applied to the surfaces of metallic endoprosthetic and dental root implants, designed to replace or restore lost functions of diseased or damaged tissues of the human body. Even though the residence time of powder particles of HAp in the plasma jet is extremely short, the high temperature applied introduces compositional and structural changes of the precursor hydroxylapatite that severely affect its chemical and physical properties and in turn, its biomedical performance. These changes are based on the incongruent melting behaviour of HAp and can be traced, among many other analytical techniques, by high-resolution synchrotron X-ray diffraction, vibrational (Raman), and nuclear magnetic resonance (NMR) spectroscopies. In vivo reactions of the plasma-sprayed coatings with extracellular fluid (ECF) can be assessed and predicted by in vitro testing using simulated body fluids as proxy agents. Ways are being discussed to safeguard appropriate biological performance of hydroxylapatite coatings in long-term service by controlling their phase content, porosity, surface roughness, residual stress distribution, and adhesion to the implant surface.

Objective To explore the endoscopic anatomical structures of lumbar surgery. Methods A total of 290 patients who underwent lumbar endoscopic surgery due to lumbar intervertebral disc (IVD) herniation from September 2020 to September 2022 were retrospectively reviewed in our hospital,179 patients had complete surgical video recordings, including 108 males and 71 females, aged from 19 to 65 years, with an average age of 41±16 years. The endoscopic structures through the intervertebral foramen and interlaminar space were independently identified by 3 doctors with more than 3 years of related surgery experience. When there were differences of opinions, the three doctors would discuss and come to a consensus. The probability, location, and neighboring structures of each specific structures were statistically analyzed. Results The anatomical structures observed through the lumbar foramen under endoscopy include muscles and ligaments attached to the superior articular process (SAP), main blood vessels inside the intervertebral foramen, blood vessels on the surface of IVD, and blood vessels on the surface of the dural sac and nerve root. The major anatomical structures observed through interlaminar space are multifidus, the conjugated ligament of ligament flavum and capsule ligament (capsule part of flavum ligaments), edges of the lamina, specific vessel bundle to facet with exit nerve root. Conclusion The anatomical structures under spinal endoscopy have certain characteristics, which are grossly different from those under open surgery. Familiarity with these anatomical structures has important clinical significance.

Gaucher Disease's (GD) pathophysiology generates anesthetic concerns in Total Hip joint Arthroplasty (THA), and due to its rareness, data on perioperative risks is scarce. This 22-year study at a large reference center addresses anesthetic management and perioperative outcomes in GD. This retrospective-cohort study assessed anesthetic success and safety in 30 THA patients, comparing them with a control-matched group. Data on clinical characteristics, perioperative events, and outcomes were collected. The primary outcome was difficult anesthesia-initiation incidence. Secondary outcomes were difficult intraoperative course and hemodynamic management, and the development of postoperative-complications. The age, sex, weight, body mass index, primary-to-revision hip arthroplasty ratio were similar in both groups. The mean age was 48±13 years. Ten arthroplasties were revision while twenty were primary. There was no significant difference at all-type anesthesia first initiation attempt success. No particular preference by staff anesthetists for general anesthesia or neuraxial procedures was observed. The GD group showed significantly higher mean intraoperative packed red blood cell units administered (0.73 vs 0.18);(p= 0.038)), higher intraoperative and postoperative platelet transfusion incidence (5/30 [16.7%] vs. 0/56 [0.00%];p=0.004) and (3/30 [10%] vs 0/56 [0%];p=0.040) and longer mean recovery-room length-of-stay (426±412 vs 175±140;p=0.004). Postoperative complications were not significantly different.

The paper analyses the national DK-model Hydrological Information and Prediction (HIP) system and HIP portal viewed as a ‘Digital Twin’ and how the introduction of real-time dynamic updating of the DK-model HIP simulations can give room for plug-in sub-models with real-time boundary conditions made available from a HIP portal. The possible feedback to a national real-time risk knowledge base during extreme events (flooding and drought) is also discussed. Under climate change conditions, Denmark is likely to experience more rain in winter, more evapotranspiration in summer, intensified cloudbursts, drought, and sea level rise. These challenges have been addressed as part of the Joint Governmental Digitalization Strategy 2016-2020 for better use and sharing of public data about the terrain, water, and climate to support climate adaptation, water management, and disaster risk reduction. This initiative included the development of a new web-based data portal (HIP portal) developed by the Danish Agency for Data Supply and Infrastructure (SDFI). GEUS delivered 5 terra-byte of hydrological model data to the portal with robust calibration methods and hybrid Machine Learning (ML) being key parts of the deliverables. The paper discusses the challenges and potentials of further developing the HIP Digital Twin with ‘plug-in Digital Twins’ for local river basins including feedback to the national level.

Cervical fusion has been a standard procedure for treating the abnormalities associated with the cervical spine. However, the reliability of anterior cervical discectomy and fusion (ACDF) has become arguable due to its adverse effects on the biomechanics of adjacent segments. One of the drawbacks associated with ACDF is adjacent segment degeneration (ASD) which has served as the base for the development of dynamic stabilization systems (DSS) and total disc replacement (TDR) devices for cervical spine. However, the hybrid surgical technique has also gained popularity recently but their effect on the biomechanics of cervical spine is not well researched. Thus, the objective of this FE study was to draw the comparison among single, bi-level and hybrid surgery with DCI implant with traditional fusion. Reduction in range of motion (ROM) for all the implanted models was observed for all the motions except extension, compared to intact model. The maximum increase in ROM of 42% was observed at C5-C6 level in Hybrid-DCI model. The maximum increase in adjacent segment’s ROM of 8.7% was observed in multilevel fusion model. The maximum von Mises stress in the implant was highest for the multilevel DCI model. Our study also showed that the shape of DCI implant permits flexion/extension relatively more compared to lateral bending and axial rotation.

Primary bone lymphoma of the spine (PBL) is a rare entity and the most shared type of non-Hodgkin lymphoma (LNH) appearing in bone lesions deprived of nodal or extra-nodal in-volvement and accounting for approximately 2% of all lymphomas. Most PBL are diffuse large B-cell lymphomas (DLBCL) and commonly involve the appendicular skeleton. Due to its atypical location and non-specific clinical imaging features mimicking certain neoplastic or infectious processes, this pathology may be misdiagnosed, thus complicating and delaying diagnosis. Our case reports a patient in her sixties who had been suffering from chronic low back pain for a year, and had gradually started to develop cruralgia and fever. She underwent a blood sample, magnetic resonance imaging (MRI), and positron emission tomography (18F-FDG-PET/CT) which revealed significant inflammatory syndrome, a pattern of spondylodiscitis at the L3-L4 level associated with morphological and metabolic invasion extending posteriorly, raising suspicion of epiduritis. No other lesions were found on the rest of the body. Neurosurgical management was performed and a biopsy was made. Histological results showed aggressive and diffuse large B-cell lymphoma, suggesting a diagnosis of PBL. This case highlights the first case of spondylodiscitis mimicking PBL in the lumbar spine, the intricacies of the diagnostic work-up, and the complexity of discriminating with an infectious process in the spine, as both have a similar, non-specific clinical presentation with different prognosis and therapeutic management.

If we accept that human body is a dissipative structure, then the recovery of the body should be considered as a redirection of the enegy flows. The recovery of vertebral cartilage through redirecting of inner dissipative flow requires the understanding of how is this case the fact of reversibility can be proven. We proposed the approach, that according to the collected data, satisfies all the scientific requirements.

Background/Objectives: The aim of the project is a longitudinal assessment of body image and mental health in scoliosis females pre-, postoperatively and in a follow-up, and implementation (one group-CBT scoliosis sample, CBTSS) or not (second group-control scoliosis sample, CSS) of CBT interventions. A healthy female sample (HFS) was also selected for comparative purposes. Methods. 36 in total AIS patients participated in the 1st and 2nd study phases, whereas 23 were eligible in the follow-up. Regarding HFS, 18 participants were included in the study. The CBT intervention took place pre- and postoperatively, during the patients' stay in hospital. Participants completed the Spinal Appearance Questionnaire (SAQ), Body Esteem Scale (BES) and Strengths and Difficulties Questionnaire-25 (SDQ-25). Body image was also assessed using a virtual reality-based application “Avatar Scoliosis 3D”. Results: The difference between the desired and objective, actual body shape is significant preoperatively both in the CBTSS and CSS at p

The natural distribution of stress in the femur is altered when total hip arthroplasty (THA) is performed. In fact, when a stem is inserted inside the femur, there is a variation in stress due to the difference in rigidity between the material with which the stem is made and the femur. This generates the phenomenon of stress-shielding. The aim of this study is to design an optimized prosthesis that guarantees excellent rotational stability and re-duced stress shielding. Methods: through the finite element method (FEM) the mechanical behavior of the stem subjected to the loads described by ISO 7206-4: 2010 is studied. Re-sults: Through topological optimization, there is a reduction in stress shielding in the proximal zone of 31.46%. The addition of ridges on the dorsal side of the stem also im-proves rotational stability by 27.82%. Conclusions: The decrease in stiffness that is rec-orded with the optimized stem, guarantees a greater distribution of stress on the bone. The presence of dorsal ridges also favors the corticalization of the bone as it loads the bone near the dorsal ensuring further stability. The perforated prosthesis presented in this study, shows an increase in primary stability and an improvement in rotational stability. As there is also a bone regrowth inside the prosthesis.

Low back pain (LBP) is a health problem that affects 70-80% of the population in Western countries. Because of the biomechanical relationship between the lumbar region and the hip, it is thought that strengthening the muscles of this joint could improve the symptoms of people with LBP. The objective of the study is to evaluate the current evidence on the efficacy of hip strengthening exercises to reduce pain and disability in people with LBP. Clinical trials were collected from PubMed, PEDro, and Scopus databases published up to September 2022. Based on Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and using CASpe and PEDro tools for methodological quality assessment, we selected studies that included hip strengthening exercises as part of LBP treatment and measured pain and/or disability parameters. Among the 966 records identified in the search, a total of 7 studies met the established selection criteria. Overall, participants who performed hip strengthening exercises had significantly improved in pain and disability. The methodological quality of the included studies was assessed as “good”. In conclusion, the addition of hip muscle strengthening exercises iterating LBP effectively improving pain and disability.

Pedigree data of 13 339 border collie dog was collected along with hip and elbow dysplasia records (1352 CHD and 524 CED), and an inbreeding-purging (IP) model was created to detect possible purging. Ancestral inbreeding coefficients were calculated by gene dropping simulation method (Ballou, 1997; Kalinowski, 2000) with GRain 2.0 (Baumung et al., 2015) software. GLMM models were created to the examined traits fitted with a log-link Poisson distribution, added to the estimated values of classical inbreeding coefficient (F_W), and the ancestral inbreeding (F_BAL, F_KAL, F_KAL_NEW) as covariates. The effective population size decreased in the examined period along with the increase of F_W however, slight differences were found as a consequence of breeding dog imports. CHD values were getting lower by the expansion of F_BAL as the alleles were inbred in the past. For CHD signs of purging were obtained. There was a positive trend regarding the breeding activity (both sire and dam of the future litters should be screened and certified free from CHD and CED), as years of selection increased the frequency of alleles with favorable hip and elbow conformation. Division of the ancestral inbreeding coefficient shows that alleles IBD for the first time (F_KAL_NEW) had a negative effect on both traits, while F_KAL shows favorable results for alleles IBD in the past generations. Some authors had proven this phenomenon in captive populations or experimental conditions however, no evidence of inbreeding purge has ever been described in dog populations. Despite the various breeding practices, it seems, that alleles of these polygenic disorders could be successfully purged out of the population with long term selection.

The severity and invasiveness of clinical outcomes from organic responses to trauma are influenced by individual, surgical and anesthetic factors. A stress response elicits neuroendocrine and immune reactions that may lead to multi-organ dysfunction. The degree of neuroinflammatory reflex activation from trauma can increase pro-inflammatory cytokine production, leading to endothelial dysfunction, glycocalyx damage, neutrophil activation and multisystem tissue destruction. A shift in patient treatment towards a neuroinflammatory perspective has prompted a new evaluation protocol for surgical patients, required to understand surgical pathogenesis and its link to chosen anesthesia-surgical methods. This study aims to provide a description of the mechanisms involved in the immune and neuroendocrine response and below is a summary of the main mediators, focusing on video laparoscopic surgeries, by examining its frequency usage by researchers. We performed a narrative review of data from databases like PubMed, MEDLINE, EMBASE, high-impact journals, and studies from the past decade that used inflammatory mediator analysis to compare anesthetic and surgical strategies. Results showed preference for certain biomarkers more sensitive to tissue trauma. These markers display distinct behaviors, temporal fluctuations and their dosages serve as a tool to measure and validate therapeutic approaches in perioperative systemic inflammation.

This study is focused on the mechanical properties of WC-Co composites obtained via Selective Laser Sintering using PA12 as a binder. The as-printed samples were thermally debonded, and sintered, first in vacuum, and then sinter-HIPed at 1400oC, using 50 bar Ar, which has led to relative densities up to 66 %. Optical metallographic images show a microstructure consisting of WC, with an average grain size in the range of 1.4 – 2.0 µm, with isolated large grains, in a well-distributed Co matrix. The shrinkage of the samples was 43 %, with no significant shape distortion. The printing direction of the samples has a great impact on the transversal rupture strength (TRS). Nevertheless, the bending strength was low, with a measured maximum of 612 MPa. SEM images of the fracture surface of TRS samples show the presence of defects that constitute the cause of the low measured values. The hardness values position the obtained composites in the range of medium coarse classical cemented carbides. The results were also related to the amount of free Co after sintering, close to the initial one, as assessed by magnetic measurements, indicating a low degree of interaction with PA12 decomposition products.

The success of total hip arthroplasty depends on the experience of the surgeon, and one of the ways the surgeon currently determines the final implant insertion depth is to listen to the change in audible pitch of the hammering sound. We investigated the use of acoustic vibration emissions as a novel method for insertion quality assessment. A non-invasive contact microphone-based measurement system for insertion depth estimation, fixation and fracture detection was developed using a simplified in vitro bone/implant (n=5). 2583 audio recordings were analysed in vitro to obtain energy spectral density functions. Out of the four main resonant peaks under in vitro conditions, broach insertion depth statistically correlates to increasing 3rd and 4th peak frequencies. Degree of fixation was also observed as higher goodness of fit (0.26-0.78 vs. 0.12-0.51 between two broach sizes, the latter undersized). Finally, however, the moment of fracture could not be predicted. A cadaver in situ pilot study suggests comparable resonant frequencies in the same order of magnitudes with the bone model. Further understanding of the signal patterns are needed for an early warning system diagnostic system for imminent fractures, bone damage, improving accuracy and quality of future procedures.

Background: Periprosthetic joint infection (PJI) following total hip and knee arthroplasty remains an extremely challenging and relatively high complication. This study aims to develop, validate and evaluate the use of machine learning (ML) algorithm to predict PJI in patients undergoing revision arthroplasties. Methods: A comprehensive review of patients undergoing hip or knee revision arthroplasty from 1 January 2015 to 31 March 2021 was conducted. Clinical data coming from preoperative patients history, laboratory analysis and demographic characteristics of patients were screened. Final data have been used to train a Logistic Regression model with the aim of predicting PJI preoperatively. Results: 1360 patients were enrolled, 1141 in the aseptic cohort and 219 in the infected cohort were included. ML demonstrated good discriminatory performance in predicting PJI in the selected patients (area under the curve 0.770 ± 0.006 in the training set and 0.720 ± 0.057 in the test set), and identified 3 significant predictors of PJI. Conclusion: ML algorithm trained using preoperative clinical data accurately predicted PJI. The incorporation of ML models into preoperative assessment of patients undergoing prosthetic revision procedures are useful in providing specific risk assessment to aid individualised counselling, shared decision making and presurgical optimization.

Objective The aim of this study was to examine the impact of a modern lifestyle on college female students' health, specifically focusing on their hip and knee joint mobility. The objective of this study was to assess the influence of hydraulic resistance training with the self-myofascial release technique on improving joint mobility in female college students. The training also aimed to compare the effectiveness of hydraulic resistance exercise with and without the self-myofascial release technique on hip and knee joint mobility.Methods The study used a randomized controlled trial design to recruit 30 female college students aged 18-25 through campus advertisements and announcements. Medical conditions or injuries that might have affected participation was screened. Participants were indiscriminately allocated to Group A (Hydraulic Resistance Training with Self-Myofascial Technique) or Group B (Hydraulic Resistance Training without Self-Myofascial Technique). The baseline assessments included joint range of motion (ROM) measurements using a goniometer. Certified trainers supervised the training sessions, and the data were analyzed using SD and mean using SPSS. ResultsThis study aimed to evaluate the impact of hydraulic resistance training with self-myofascial release on hip and knee joint mobility in female college students. The results showed that both groups showed improved hip and knee flexion with and without the self-myofascial release technique. However, the Group A using the self-myofascial release technique (Group A) showed a more significant enhancement, as indicated by the smaller p value compared to Group B. It has been suggested that the self-myofascial release technique may improve hip and knee joint mobility. ConclusionThis study concluded that Hydraulic Resistance Training with Self-Myofascial Release (HSMR) could improve hip and knee joint mobility among female college students. These findings suggest that integrating the self-myofascial release technique into training regimens can improve joint mobility. However, further research with larger sample sizes and extended intervention periods was needed to understand the long-term effects and sustainability of these improvements.

Preliminary clinical data suggest pain reduction through fasting in different diagnoses. This uncontrolled observational clinical study examined the effects of prolonged modified fasting on pain and functional parameters in hip and knee osteoarthritis. Patients admitted to the inpatient department of Internal Medicine and Nature-based Therapies of the Immanuel Hospital Berlin between February 2018 and March 2020, answered questionnaires at the beginning and end of inpatient treatment, as well as 3, 6 and 12 months after discharge. Additionally, selected blood and anthropometric parameters were routinely assessed during the inpatient stay. Fasting was performed as part of a multimodal integrative treatment program, with daily caloric intake of <600 kcal for 7.7 ± 1.7 days. N=125 consecutive patients were included. Results revealed an amelioration of overall symptomatology (WOMAC Index score: -14.8±13.31; p<0.001; d=0.78), and pain alleviation (NRS Pain: -2.7±1.98, p<0.001, d=1.48). Pain medication was reduced, stopped, or replaced by herbal remedies in 36% of patients. Improvements were also observed in secondary outcome parameters, including increased quality of life (WHO-5: +4.5±4.94, p<0.001, d=0.94), reduced anxiety (HADS-A: -2.1±2.91, p<0001, d=0.55) and depression (HADS-D: -2.3±3.01, p<0.001, d=0.65), decreases in body weight (-3.6 kg ± 1.65, p< 0.001, d=0.21), and blood pressure (systolic: -6.2±15.93, p<0.001, d= 0.43; diastolic: -3.7±10.55, p<0.001, d=0.43). Results suggest that patients with osteoarthritis of the lower extremities may profit from a prolonged fast embedded in a multimodal integrative treatment regarding quality of life, pain, and disease-specific functional parameters. Confirmatory RCTs are warranted to further investigate these hypotheses.

Background: Spine shape parameters, such as leg length, kyphotic or lordotic angle, are influenced by low back pain. There is also evidence that the thoracolumbar fascia plays a role in such pa-thologies. This study examined the immediate effects of a myofascial release technique (MFR) on the thoracolumbar fascia and of an osteopathic treatment (OMT) on postural parameters in pa-tients with acute low back pain (aLBP). Methods: This study was a single-blind randomized pla-cebo-controlled trial. Seventy-one subjects (43.8 ± 10.5 years) suffering from aLBP were randomly and blinded assigned to three groups to be treated with MFR, OMT or a placebo intervention. Spinal shape parameters (functional leg length discrepancy (fLLD), kyphotic angle, lordotic an-gle) were measured before and after the intervention using video raster stereography. Results: Within the MFR group, fLLD reduced by 5.2 mm, p < 0.001 and kyphotic angle by 8.2 degrees, p < 0.001. Within the OMT group, fLLD reduced by 4.5 mm, p < 0.001 and kyphotic angle by 8.4 °, p = 0.007. Conclusion: MFR and OMT have an influence on fLLD and the kyphotic angle in aLBP patients. The interventions could have a regulating effect on the impaired neuromotor control of the lumbar muscles.

The ACEtabular rim eXtension (ACE-X) implant is a custom-made 3-dimensional-printed titanium device designed for the treatment of canine hip dysplasia. Thirty-four dogs (61 hips) underwent ACE-X implantation, and assessments were conducted using computed tomography, force plate analysis, Ortolani’s test, and Helsinki Chronic Pain Index (HCPI) questionnaires at five intervals: pre-operative day, surgery day, 1.5-month, 3-month, and 12-month follow-up. Statistically significant increases in femoral head coverage with negative Ortolani subluxation test were observed immediately after surgery and persisted throughout the study. Osteoarthritis (OA) scores remained stable, but osteophyte size significantly increased between the surgery day and the 12-month follow-up, especially in hips with a baseline OA score of 2 compared to those with a score of 1. Force plate data showed no significant changes during the study. The HCPI demonstrated a significant decrease in pain score from pre-operative value to 6-week follow-up and gradually decreased over time. Major complications were identified in 6 hips (9.8%) of 4 dogs. In conclusion, the ACE-X implant effectively increased femoral head coverage, eliminated subluxation, and provided long-term pain relief with minimal complications, benefiting over 90% of the study population. The study supports the ACE-X implant as a secure and valuable treatment for canine hip dysplasia.

Most common classifications for acetabular bone defects are based on radiographic two-dimension imaging, with low reliability and reproducibility. With the rise of modern processing techniques based on 3D modelling, methodologies for volumetric quantification of acetabular bone loss are available. Our study aims to describe a new methodology for quantitative assess-ment of acetabular defects, based on 3D modelling, focused on the surface analysis of the integrity of the main anatomical structures of the acetabulum represented by four corresponding sectors (posterior, superior, anterior, and medial). The defect entity is measured as the Area Increase Ra-tio (AIR) detected in all the sectors analyzed on three planes of view (frontal, sagittal and axial) compared to healthy hemipelvises. The analysis was performed on 3D-models from the CT-scan of six exemplary specimens with a unilateral pathological hemipelvis. AIR between the native and the pathological hemipelvis was calculated for each sector, for a total of 48 analysis (range, +0.93% - +171.35%). AIR of >50% were found in 22/48(45.8%) sectors and affected mostly the posterior, medial and superior sectors (20/22, 90.9%). Qualitative analysis showed consistency of the data with the morphological features of the defects. Further studies with larger samples are needed to validate the methodology and potentially develop a new classification scheme.

Background: Recent studies have found forward head posture (FHP) to be associated with altered physiology, however, there is a lack of research into whether FHP is associated with altered gait parameters when cognitively challenged. The current study was undertaken to investigate the changes in gait parameters in asymptomatic individuals with FHP when a cognitive dual task is introduced during walking. Methods: Ninety asymptomatic participants were recruited, 45 having FHP defined as having a craniovertebral angle (CVA) &lt; 50, and 45 sex and age-matched controls having normal head posture (NHP) defined as CVA &gt; 55. All participants walked along a 10 meter platform under a control condition (no cognitive load) with 3 consecutive trials while an optical motion-capture system consisting of 8 infrared cameras was used to assess gait kinematics. Secondly, participants were assessed under a dual task cognitive load condition (3 trials while performing simple addition, counting backwards, and answering yes or no questions) to identify the impact on gait kinematics compared to the control condition. Results: Under the single task condition, there were no significant differences for any gait parameter, however, under the dual task condition, 12/13 gait parameters were significantly altered for the FHP group compared to the NHP group (p &lt; .01). A calculation of dual task cost (DTC) percentage showed significant increases in all gait parameters in participants with FHP (p &lt; .02). Correlations between the CVA and gait parameters were not significant for the single task condition, but all gait parameters were correlated to CVA for the dual task condition (p &lt; .01). The correlation between CVA and DTC for all gait variables were also significant (p &lt; .04). Conclusions: This study demonstrates that FHP significantly increases the cognitive cost during walking, highlighting the importance of proper postural alignment for maintaining cognitive function under a dual task condition. Addressing FHP through targeted interventions could improve both physical and cognitive health, enhancing overall well-being and daily functioning.

Hip replacement has significantly improved the quality of life of patients with symptomatic hip osteoarthritis. Metal-on-metal (MoM) bearings have been used with conventional total hip re-placement (THR) for several decades with promising results from early applications. Wear and corrosion of these implants may lead to a release of metal products into surrounding tissue and body fluids. From the 1980s onwards, the search for increasingly better coupling materials with low levels of wear led to the rise of hard-on-hard couplings such as ceramic-on-ceramic (CoC). The latter is currently the coupling with the longest known duration and with a wear rate close to zero. MoM coupling has been for a long time the most significative alternative, but systemic and local complications linked to the release of chromium and cobalt ions, determine the withdrawn from the market. One other alternative proposed over the time has been Ceramic-on-Metal (CoM) bearing. Preliminary results have been described as favourable, but due to the failures of metal on metal it has been withdrawn from the market, without causing significant clinical complications. In this narrative review, we analysed risks and benefits associated with the implantation of hybrid hard-on-hard bearings, such as CoM.

Background: GaitSmart (GS) is a sensor-based digital medical device that can be used with the integrated app vGym to provide a personalised rehabilitation programme for older people undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). This study aimed to determine whether the GS intervention used in the rehabilitation of older people undergoing THA or TKA is potentially cost-effective compared to the current standard of care (SoC). Methods: Decision-analytic modelling was conducted to estimate cost-effectiveness over a seventeen- week time horizon, from an NHS perspective. UK clinical and cost data from the GaitSmart randomised clinical trial was used to obtain input parameters, and sensitivity analysis was performed to address uncertainty. Results: Over a seventeen-week time horizon, GS incurred cost savings of £450.56 and a 0.02 gain in quality-adjusted life years (QALYs) compared to the SoC. These results indicate that GS is the dominant intervention because the device demonstrated greater effectiveness and lower costs. Probabilistic sensitivity analyses confirm the robustness of our results. Conclusion: GS appears to offer short-term efficiency benefits and demonstrates cost-effectiveness for the improvement of gait in people undergoing THA or TKA, compared to the SoC. These findings provided new evidence to inform policymakers.

Advanced manufacturing techniques, aimed at implants with high dependability, flexibility, and low manufacturing costs, are crucial in meeting the growing demand for high-quality products like biomedical implants. Incremental sheet forming is a promising flexible manufacturing approach for rapidly prototyping sheet metal components using low-cost tools. Titanium and its alloys are used to shape most biomedical implants because of its superior mechanical qualities, biocompatibility, low weight, and great structural strength. The poor formability of titanium sheets at room temperature, however, limits their widespread use. The goal of this research is to show that gradual sheet formation of a titanium biomedical implant is possible. The possibility of creative and cost-effective concepts for the manufacturing of such complicated shapes with significant wall angles is explored in this study. A numerical simulation based on finite element modeling as well as a design process tailored to metal forming is used to complete the development. The mean of uniaxial tensile tests with a constant strain rate was used to study the flow behavior of the studied material. To forecast the crack, the obtained flow behavior was modeled using the behavior model and failure model.

Purpose: In recent years, there has been an increasing interest in simultaneous hip and knee arthroplasty compared to staged procedures. The aim of this study was to clarify some controversies and show the safety for the patients by comparing the transfusion rate, postoperative hemoglobin drop, length of stay (LOS), in-hospital complications, 30-day readmissions, and early functional outcome after simultaneous and staged hip and knee arthroplasty. Methods: We conducted a retrospective trial that included all patients who were undergoing primary TKA, THA, and UKA by one single surgeon in a high-volume arthroplasty center between 2017 and 2020 as a simultaneous or staged procedure. Staged bilateral arthroplasties were performed within 12 months and were stratified by the time between procedures. Data was acquired through the electronic files at the OCM. For functional outcome, we compared the ability of the patients to walk independently on the ward and the ability to walk a set of stairs alone which was daily recorded by the attending physiotherapist. Results: In total 305 patients were assessed for eligibility and included in this clinical trial. 145 patients were allocated to the staged arthroplasty group. That group was subdivided in a hip and a knee group, whereas the knee group was split in TKA and unicompartmental knee arthroplasty (UKA). The second staged procedure was performed within 12 months of the first procedure.160 patients were allocated to the simultaneous arthroplasty group. This group was also subdivided into a hip and knee group, whereas the knee group was split again into a TKA and UKA group. No statistical difference was found between the two groups regarding demographic data. Primary outcome measurements: There is no significant difference in transfusion rate or complication rate. Secondarily: No correlation was found between the Hb-drop and the functional outcome as well as the length of stay (LOS). Walking the stairs showed a significant difference in the knee group. Conclusion: We observed no significant differences in transfusion rate, in-hospital complications, as well as readmission rate. The early functional outcome showed no significant difference in mobility for all groups. Simultaneous arthroplasty for knee or hip is as safe as a staged procedure, with no higher risk for the patient and his outcome, in a high-volume center.

This study explores the application of the Laban/Bartenieff Movement System (® LBMS), particularly its Effort component, to analyze the biomechanical dynamics of the golf swing. Focusing on the initiation of the downswing, this paper investigates how the instantaneous screw axis (ISA) with rotational and linear motions contributes to subsequent movements, such as the hip turn. We propose that the physical forces generated by the golf club, characterized by mass moment inertia, extend beyond the body's boundaries, such as through the hand grip. A skilled golfer’s ability to 'allow' these forces to influence body dynamics without opposing them is analyzed through the lens of LBMS's Free Flow Effort, suggesting an indulgent and expansive use of movement energy.

The aim of this study was to examine the relationship of the distance between the apex tip of the upper central tooth (U1A) and the anterior nasal spine (ANS) and the nasal floor (NF) with the vertical cephalometric values using cone-beam computerized tomography (CBCT). A total of 122 patients who applied to Department of Orthodontics between January 2011-June 2019 were included. On the CBCT’s, distances between the U1A and the NF and ANS were measured. Statistical significance was considered as p&lt;0.05. Of 122 individuals 73.8% (n=90) were female and 26.2% (n=32) were male with an mean age of 22,8±3,3 years. A statistically significant moderate positive correlation was found between the NF-U1A mean values and the measurements of N-Me, ANS-Me and ANS-Gn, S-Go, and N-ANS measurements (p &lt;0.01). A statistically significant positive correlation was found between the ANS-U1A mean values and Ar-Go-Me, total posterior angles, N-Me, SN/GoGn and Y-axis angle, ANS-Me and ANS-Gn (p &lt;0.01). In this study, we found that the distance of U1A from ANS and NF points was related to orthodontic vertical direction parameters. It was demonstrated that the ANS-U1A and NF-U1A points can serve as reference points for identifying the orthodontic vertical growth pattern on CBCT scans.

Abstract: In complex revision total hip arthroplasties, careful preoperative planning is crucial for the proper reconstruction of hip biomechanics. With conventional 2D radiographic images and computed tomography (CT) the 3D extension of the defect and the remaining bone stock may not be evaluated properly. 3D printed models can aid the surgeon in planning complex acetabular re-construction. The purpose of this study is to compare the accuracy of bony defect assessment in severe acetabular defects surgery with 3D printing planning as compared to conventional 2D ra-diographic planning and CT. Twenty-five patients with severe acetabular defects (Paprosky IIC and III) undergoing revision surgery were enrolled. Each patient had a 3D printed model of their femur and pelvis created based on CT scans. Clinical and radiographic assessments were conducted before and after surgery, with four key bone landmarks measured and compared between X-ray, CT, 3D models, and surgical reports. The findings revealed discrepancies in defect assessment between different imaging methods. X-rays and CT scans sometimes incorrectly identified affected areas, while the 3D models showed more accurate results. This study suggests that 3D printed models can significantly improve the preoperative evaluation of complex hip arthroplasty revisions, enabling surgeons to better select optimal surgical strategies.

Introduction The Pericapsular Nerve Group (PENG) block is a novel technique that allows for analgesia of the anterior hip capsule via the articular branches of the accessory obturator nerve and femoral nerve, which have a significant role in the innervation of the hip capsule. PENG blockade is effective in both adult and pediatric patients. However, there are no studies in the available literature on patients under five years of age. Herein, we describe our experience with two pediatric patients with hip dysplasia. Purpose This study aimed to evaluate the analgesic effect of the pericapsular nerves group (PENG) in small children undergoing hip surgery. Patients and methods This study included two patients, aged 2 and 4 years old, who qualified for hip surgery. General or spinal anesthesia with the addition of a PENG block was performed. During the procedure, the basic hemodynamic parameters were monitored. After the surgery, the patients received 15mg/kg-1 iv paracetamol every 6 hours to prevent rebound pain. The pain was assessed using the FALCC score. The 15mg/kg-1 metamizole was administered if the FLACC score was 3. In the FLACC score 4, the application of 0,2mg/kg-1 Nalpain was ordered. Results The patient's hemodynamic parameters were stable and within normal range. FLACC scores from all patients ranged from 0 and 3 in the first 24 h period. One patient required metamizole 12 hours after surgery. No evidence of block complications was observed. Conclusions This case series showed that PENG block provided adequate postoperative analgesia and assured opioid-free pain management. However, we are convinced that future randomized, controlled trials are needed in this field.

Introduction:The concept of same-day discharge has garnered increasing significance within orthopedic surgery, particularly in hip and knee procedures. Despite initial concerns surrounding the absence of prolonged hospital care, a burgeoning body of evidence highlights numerous advantages associated with same-day discharge, ranging from mitigating in-hospital infections to offering substantial financial and psychosocial benefits for both patients and healthcare providers. In this study, we aim to scrutinize the trends in same-day discharge specifically within the realm of total hip arthroplasties. Method:This retrospective analysis delves into the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database spanning from 2016 to 2021. Result:In this study, same-day hip patients skewed younger, comprising 48.3%females compared to 55.6% in hospitalized hip patients. Operatively, same-day hip surgeries boasted shorter durations, averaging 83.9 minutes, in contrast to the 92.3minutes for hospitalized hip procedures. Postoperatively, same-day hip patients exhibited significantly diminished rates of 30-day readmissions (1.7%vs. 3.5%), procedure-related readmissions (1.0%vs.2.1%), reoperations (1.1%vs.1.9%), and mortality (0.02% vs. 0.04%). In addition, we found that that unplanned readmissions in the same-day group are significantly predicted by being over 65 years old (OR: 2.0), having hypertension (OR: 1.6), chronic steroid usage (OR: 2.2), and severe COPD (OR: 2.0), while gender, emergent surgery indication, and smoking were not significant predictors. Moreover, the prevalence of the same-day discharge concept experienced a remarkable ascent from 2016 to 2021, with rates escalating from 1.5% to 25.6% of all total hip arthroplasties over a span of just six years. Conclusion:In conclusion, same-day discharge is a feasible and safe option for selected THA patients, improving healthcare efficiency and patient satisfaction.

Total hip arthroplasty (THA) is one of the most successful orthopedic procedures and is highly effective in improving function and quality of life. However, after discharge patients commonly experience edema, which can lead to health consequences and lower quality of life. For these rea-sons, the aim of this study is to evaluate the effectiveness of a specific intermittent leg pneumatic compression on lower limb edema and physical outcomes in patients after total hip arthroplasty, compared to standard conservative treatment. A total of 47 patients were enrolled and randomly allocated into two groups: the pneumatic compression group (PG=24) and the control group (CG=23). We evaluated thigh and calf circumferences, knee and ankle range of motion, pain and walking autonomy. Our results showed a greater reduction in thigh and calf circumference for PG (p<0.001), while other outcomes were similar for the two groups (p>0.05). The combination of standard therapy with pneumatic leg compression was more effective in reducing lower limb edema, thigh, and calf circumferences compared to the use of standard treatment. Our results suggest that pressotherapy treatment is a valuable and efficient option for managing lower limb edema and preventing VTE after THA.

A multicenter, prospective cohort study conducted in 5 physiotherapy clinics in the UAE from January 2021 to March 2023 to assess coronal lumbar spine radiographic parameters as a predictor of conservative therapy outcomes in patients suffering from low back and leg pain due to lumbar disc herniation (HNP). Ninety patients (mean age 44 yrs., 54% male) with lumbar HNP underwent conservative therapy. All participants received lumbar spine MRI and radiography to assess spine alignment. Interventions included specific exercises, diathermy, traction, education, a home-based exercise pro-gram, and medications. Detailed demographic data was collected. Follow-up was 6-months after discharge. A successful outcome was based on a minimum of the following four outcomes: (1) reduction of pain by 17.5 points (0–100 NRS); (2) fatigue reduction by 7.5 points; (3) distress reduction by 5 points; and (4) interference reduction by 9.5 points. At 6-month follow-up it was found that patient age, education, and radio-graphic determined lumbosacral angle measures significantly affected the odds of a successful outcome. Increasing age 1-year significantly decreased the odds of success of improving pain, fatigue (OR = 0.85, p = 0.016) and interference scores (OR = 0.89, p = 0.042) by 15%, 15%, and 11% respectively. Lower education significantly increased the odds of success for improving pain, fatigue, and interference by 26.18, 26.18, and 7.5 (p = 0.006, = 0.006, and = 0.029 respectively). Increasing (worsening) the radiographic lumbosacral angle by each 1° significantly reduced the odds of success for improving pain, fatigue, distress, and interference by 3.52, 3.52, 27.99, and 2.55, respectively (p < 0.001, < 0.001, = 0.003, = 0.001). Our findings indicate that younger age, less education, and better coronal radiological lumbar spine alignment all had a substantial impact on the likelihood of success of 6-month outcomes in patients suffering from chronic lower back pain and radiculopathy due to HNP.

Background: due to increase in total hip arthroplasties (THAs), the incidence of periprosthetic hip fractures (PPHFs) is forecast to raise considerably in the next decades, with Vancouver B1 fractures (VB1) accounting for one third of total cases. Femur fixation with cerclages (with or without screws) is considered the current treatment option for intraoperative VB1. Methods: the study retrospectively includes data from patients who developed VB1 PPHFs during THAs from December 3rd 2020 to November 30th 2022. The primary outcome of this study was to identify the reintervention-free survival rate. The secondary aim was to determine clinical and radiographic assessment at follow-up, based on Harris hip score (HHS) and limb length discrepancy (LLD). Results: 37 patients with mean age 60.03 ± 15.49 (22 to 77) years old were included. Overall, the Kaplan-Meier estimated a re-operation free survival rate of 99% (CI 95%) at 6 months. The mean limb length discrepancy (LLD) improved from -3.69±6.07 (range -27.9 to 2.08) mm to 0.10±0.67 (range -1.07 to 1.20) mm. The mean HHS improved from 42.72±14.37 (range 21.00-96.00) to 94.40±10.32 (range 56.00-100.00).

(1) Background: Pseudotumor of the hip is a sterile, non-neoplastic soft tissue mass associated with total hip arthroplasties. Pseudotumors may mimic soft tissue tumors, or infections, so the differential diagnosis is crucial and biopsy is recommended. The purpose of this study was to compare complications and functional results between one-stage and two-stage procedures. (2) Methods: We retrospectively analyzed 21 patients surgically treated at our Institution with “pseudotumor” associated with hip prosthesis (8 male,13 female; mean age 69 years). One-stage revision was performed in 10 cases, two-stage in 10, excision only in one case. Complications were classified as major and minor and functional results assessed using the Harris Hip Score (HHS). (3) Results: Five patients (24%) reported major complications. Survival rate to all com-plications was 75%. Overall survival was 95% at five years. Mean HHS went from 35 pre-operative to 75 post-operative, highlighting improved functional results in all cases. We rec-orded no differences in complications and functional outcome between one and two-stage proce-dures. (4) Conclusions: In our experience, two-stage surgical approach is preferable in cases with major bone defects and larger pseudotumor size. The use of custom-made 3D-printed prostheses is increasing and is a further reason to prefer two-stage revision.

A standard method assessing postural control is the measurement in standing position. However, the implementation is usually only possible to a limited extent. Recording of postural control directly on the trunk, in seated position, could provide an alternative diagnostic method for quantifying neuromuscular control. Comparison of the measurements of Center of Pressure (CoP) in standing and seated position was performed on 66 healthy adult subjects. Reliability of measurements in seated position was tested on 23 subjects. In addition, the extension force of all test subjects was recorded. The assessments of CoP fluctuations in standing and seated position showed adequate agreement (deviation 9.1%). Furthermore, good internal consistencies with a sufficient test re test reliability could be demonstrated for the measurements in seated position. Both CoP measurement methods showed a comparable Spearman correlation to obtained extension force measurements (standing: 0.24, seated: 0.23). Our results show that recording CoP flucutations in the seated position is a reliable and valid additional method to measurements in the single legged stance. It could serve as an additional alternative to quantify neuromuscular control in impaired patients in whom single-leg stance cannot be performed adequately. In addition, the measurement in sitting position enables the direct recording of neuromuscular control on the trunk.

Background: The growth of arthroplasty procedures requires innovative strategies to reduce inpatients Length of Stay (LOS). This study aims to develop a machine learning prediction model that may aid to predict LOS after hip or knee arthroplasties. Methods: A collection of all the clinical notes of patients undergoing elective primary or revision arthroplasty from 1 January 2019 to 31 December 2019 was performed. The hospitalization has been classified as “Short LOS” if it was less than or equal to 6 days and “Long LOS” if it was greater than 7 days. Clinical data coming from pre-operative laboratory analysis, vital parameters, demographic characteristics of patients were screened. Final data have been used to train a Logistic Regression model with the aim of predicting short or long LOS. Results: Final dataset was composed of 1517 patients (795 “LONG”, 722 “SHORT”, p = 0.3196) with a total of 1541 admissions (729 “LONG”, 812 “SHORT”, p &lt; 0.000). Complete model had a prediction efficacy of 78,99% (AUC 0.7899). Conclusions: Machine learning may facilitate day-by-day clinical practice predicting which patients are suitable for a shorter LOS, from those with a longer LOS in which a cautious approach could be recommended.

Degenerative disc disease (DDD) is a pervasive condition that limits quality of life and burdens economies. Traditional pharmacological treatments aimed at slowing degeneration are ineffective in the long-term. Orthobiologics, regenerative agents derived from the patient’s own tissue, are a promising emerging therapy for degenerative disc disease. This review first outlines the pathophysiology of degenerative disc disease, highlighting the limitations of existing treatments and explores the orthobiologic tools for treating degenerative disc disease (platelet-rich plasma, mesenchymal stem cells). Their history in regenerative medicine is outlined, demonstrating how in vitro evidence informed preclinical animal studies on their efficacy in treating degenerative disc disease. Finally, clinical trials utilizing these treatment options are reviewed and directions for future research are outlined. Although the current clinical evidence available is limited to propagate their routine clinical usage the field holds immense potential in the management of DDD. There is room for these treatments to be optimized for effective consistent clinical outcomes in DDD.

Introduction: Anterior Lumbar Interbody Fusion (ALIF) and Posterior Spinal Fusion (PSF) play pivotal roles in restoring lumbar lordosis in spinal surgery. Debates persist between combined single-position surgery and traditional prone-position PSF for optimizing segmental lumbar lordosis. Research Question: The study investigates the impact of performing ALIF in the supine position followed by PSF in the prone position on segmental lumbar lordosis. Material and Methods: A cohort of 59 patients underwent ALIF and PSF at a single institution. Preoperative, post-ALIF supine, and post-PSF prone Cobb angles were assessed using x-ray imaging. Statistical analyses, including one-way repeated measures ANOVA and Post-hoc analyses with Bonferroni adjustment, were employed for mean comparisons within subjects. Results: The mean Cobb angle for the entire cohort showed significant variations over different time points (p).

Background: Early diagnosis of postoperative complications is an urgent task, allowing timely prescribing of appropriate therapy and reducing the cost of patient treatment. Prognostic models based on various data could help in the early diagnosis of postoperative complications after cardiac surgery. Objectives: The purpose of the study was to determine whether an integrated approach based on clinical data along with metabolites and biomarkers had greater predictive value than the models built on less data. Methods: The study included patients (n=62) admitted for planned cardiac surgery (coronary artery bypass grafting with cardiopulmonary bypass), who were retrospectively divided into two groups depending on the presence (n=26) or absence (n=36) of postoperative complications of all types. Clinical and laboratory data on the first day after surgery were analyzed. Additionally, patients' blood samples were collected before and on the first day after surgery to determine biomarkers (interleukin-6, procalcitonin, NT-proBNP, high-sensitivity troponin T) and metabolites (8 aromatic and 2 dicarboxylic acids were detected using gas chromatography-mass spectrometry). Results: Patients before surgery, compared with healthy donors, differed in the concentration of metabolites (p &lt; 0.05), and had concentrations of a number of biomarkers exceeding the corresponding reference values. Multivariate PLS-DA models, predicting the presence or absence of postoperative complications, were built using clinical data (ROC-AUC=0.71), concentrations of metabolites and biomarkers (ROC-AUC=0.60), and the entire data set (ROC-AUC=0.75). For comparison we built univariate models using the EuroScore2 (ROC-AUC=0.59) and SOFA (ROC-AUC=0.76) scales; concentrations of lactate (ROC-AUC=0.71), the dynamic changes of 4-hydroxyphenyllactic acid (ROC-AUC=0.69), and the sum of three sepsis-associated metabolites (ROC-AUC=0.70). The proposed complex model using entire data set was comparable to the SOFA scale, which confirms the expediency of searching for new predictive models based on a variety of factors.

Milk serves as a crucial source of natural bioactive compounds essential for human nutrition and health. The gastrointestinal digestion of milk proteins releases various biologically active peptides that positively impact human health and enhance physiological performance. With the growing production of cheese, Greek yogurt, and other dairy products, the volume of unutilized acid whey is significantly increasing. Acid whey, containing almost all whey proteins and approximately one-quarter of casein, presents a valuable raw material for generating peptides with potential health benefits. These peptides exhibit properties such as antioxidant, antimicrobial, anti-inflammatory, anticarcinogenic, antihypertensive, antithrombotic, opioid, mineral-binding, and growth-stimulating activities, contributing to improved human immunity and the treatment of chronic diseases. Enzymatic hydrolysis of milk proteins has been developed as a method to produce these peptides, facilitating their use in food fortification. To incorporate whey into functional beverages, it undergoes fermentation by lactic acid bacteria with proteolytic activity. To specifically enrich these beverages with peptides exhibiting targeted bioactivities, it is essential to select lactic acid bacteria strains possessing the requisite protease profiles. Additionally, the sensory properties of the final product can be enhanced using starter cultures with diverse metabolic capabilities, even in the absence of added flavoring agents. Given the imperative to develop waste-free technologies and enhance the profitability of the dairy industry, there is a growing need to efficiently utilize and transform acid whey into a broad spectrum of valuable products and food additives. This approach is justified not only by the nutritional benefits of the bioactive components in whey but also by the commercial potential of safe and health-enhancing products.

The paper focuses on the application of a multilevel, integrative and territorial approach to the protection of cultural heritage through planning instruments in Serbia. It points out the problems of the sectoral approach and discusses international recommendations that can be integrated into the planning methodology. The case study is the area of Djerdap National Park, which has an already established international and national importance. The research suggests that the cultural heritage in the area, with the exception of the Roman limes, is still recognized at the level of individual localities. The study emphasizes the importance of aligning all levels of governance to safeguard the whole spatial entity rather than focusing solely on its particular areas. The interna-tional and national importance of the planning area contributes to the strengthening of awareness of heritage and its institutional protection. However, the vitality of the area, which is key to its sustainable development, comes from the local level. Planning documents contribute to the inte-gration of local values and local communities into development programs and projects.

The impact of interaction SS with MJO on rainfall along Java Island to East Nusa Tenggara has been studied using daily rainfall observation data from 2140 weather observation stations, which are also equipped with GSMaP, OLR, and ERA5 data. There were 61 SS events found, 17 during active MJO and 44 in inactive MJO. Rainfall increases more in the western study area when the active MJO and more in the eastern study area when the inactive MJO is due to SS. SS reduces rainfall in the Jakarta region, regardless of the activity or inactivity of the MJO. SS causes extreme rainfall to only occur in a small part of certain areas, so it tends to significantly reduce the possibility of extreme rainfall. In the southern part of the IMC, SS predominates over MJO in supporting increased water vapor transport. Large-scale synoptic circulations like the monsoon, SS, and MJO can interact with local land-sea wind circulation to produce spatiotemporal variability in rainfall on Java Island. Rainfall mostly increases in the afternoon and decreases in the morning when SS occurs, whether there is MJO or not. Convective instability analysis indicates that SS increases precipitation, most likely by lowering CIN and raising VIMFC.

In order to shorten the detection time and improve the average precision on embedded devices, A lightweight and high accuracy model is proposed for passion fruit in complex environments (backlight, occlusion, overlap, sunny, cloudy, rainy). Firstly, replacing the backbone network of YOLOv5 with a lightweight GhostNet model reduces the number of parameters and computation while improving detection speed. Secondly, a new feature branch is added to the GhostNet network, and the feature fusion layer in the neck network is reconstructed to effectively combine the lower-level and higher-level features, which not only improves the accuracy of the model but also maintains its lightweight. Finally, the knowledge distillation methods are used to transfer the knowledge from the more capable teacher model to the less capable student model, which significantly improving the detection accuracy. The improved model is denoted as G-YOLO-NK. The average accuracy of the G-YOLO-NK network is 96.00%, which is 1.00% higher than the original YOLOv5s model. Furthermore, the improved model size is 7.14MB, reduced to half of the original model, and the real-time detection frame rate is 11.25 FPS on the Jetson Nano. Compared to the state-of-the-art model, the proposed model outperforms them in terms of average precision and detection performance. The present work provides an effective model for real-time detection of passion fruits in complex orchard scenes, which can provide valuable technical support for the development of orchard picking robots and greatly improve the intelligence level of orchards.

The Simultaneous Localization And Mapping (SLAM) scanner is an easy and portable Light Detection And Ranging (LiDAR) data acquisition device. Its main output is a 3D point cloud covering the scanned scene. Regarding the importance of accuracy in the survey domain, this paper aims to assess the accuracy of two SLAM scanners: the NavVis VLX and the BLK2GO Scanner. This assessment is conducted for both outdoor and indoor environments. In this context, two types of reference data are used: the Total Station (TS) and the static scanner Z+F Imager 5016. To carry out the assessment, four comparisons are tested: cloud to cloud, cloud to mesh, mesh to mesh, and edge detection board assessment. However, the results of the assessments confirm that the accuracy of indoor SLAM scanner measurements (5 mm) is greater than that of outdoor ones (between 10 mm and 60 mm). Moreover, the comparison of cloud to cloud provides the best accuracy regarding direct accuracy measurement without manipulations. Finally, based on the high accuracy, scanning speed, flexibility, and the accuracy differences between tested cases, it is confirmed that SLAM scanners are effective tools for data acquisition.

In recent years, electroencephalogram (EEG) emotion recognition has emerged as a research hotspot in the field of artificial intelligence (AI). Despite advancements in EEG-based emotion recognition, room for enhancing performance persists due to EEG signal redundancy and limitations in feature extraction, leading to inefficient models and emotional information loss. To fully utilize EEG's emotional information and improve recognition accuracy while reducing computational costs, this paper proposes a Convolutional-Recurrent Hybrid Network with a dual-stream adaptive approach and an attention mechanism (CSA-SA-CRTNN). Firstly, the model utilizes a CSAM module to assign corresponding weights to EEG channels. Then, an adaptive dual-stream convolutional-recurrent network (SA-CRNN and MHSA-CRNN) is applied to extract local spatial-temporal features. After that, the extracted local features are concatenated and fed into a temporal convolutional network with a multi-head self-attention mechanism (MHSA-TCN) to capture global information. Finally, the extracted EEG information is used for emotion classification. We conducted binary and ternary classification experiments on the DEAP dataset, achieving 99.26% and 99.15% accuracy for arousal and valence in binary classification, and 97.69% and 98.05% in ternary classification, surpassing relevant algorithms. Additionally, the model's efficiency is significantly higher than other models, achieving better accuracy with lower resource consumption.

Glycosidic linkage analysis was conducted on the unfractionated polysaccharides in the alcohol-insoluble residues (AIRs) prepared from six red seaweeds (Gracilariopsis sp., Prionitis sp., Mastocarpus papillatus, Callophyllis sp., Mazzaella splendens, and Palmaria palmata) using GC-MS/FID analysis of partially methylated alditol acetates (PMAAs). The cell walls of P. palmata primarily contained mixed-linkage xylans and small amounts of sulfated galactans and cellulose. In contrast, the unfractionated polysaccharides of the other five species were rich in galactans displaying diverse 3,6-anhydro-galactose and galactose linkages with varied sulfation patterns. Different levels of cellulose were also observed. This glycosidic linkage method offers advantages for cellulose analysis over traditional monosaccharide analysis that is known for underrepresenting glucose in crystalline cellulose. Relative linkage compositions calculated from GC-MS and GC-FID measurements showed that anhydro sugar linkages generated more response in the latter detection method. This improved linkage workflow presents a useful tool for studying polysaccharide structural variations across red seaweed species. Furthermore, for the first time, relative linkage compositions from GC-MS and GC-FID measurements, along with normalized FID and total ion current (TIC) chromatograms without peak assignments, were analyzed using principal component analysis (PCA) as a proof-of-concept demonstration of the technique's potential to differentiate various red seaweed species.

Background: Educating college students about the importance of good sleep habits could lead to the adoption of healthier sleep routines, including sufficient sleep duration and sleep quality. The current pre-post study examines the impact of completing a sleep education program called “Sleep 101” on (1) sleep hygiene practices, (2) sleep quality, and (3) weekday and weekend sleep behaviors among college students. “Sleep 101” is an interactive online course developed to educate college students about the importance of sleep by addressing basic sleep physiology, the impact of sleep on mood, academic and physical performance, the interactions between sleep and various substances, and common sleep disorders. Methods: 338 college students were recruited from a midsized public university in the US and invited to participate in “Sleep 101”, of which 25 participants completed the baseline and post-intervention questionnaire. The Sleep Hygiene Index (SHI) was utilized to evaluate sleep hygiene practices, while standard questions were employed to assess weekday and weekend sleep behaviors and overall sleep quality. Results: Those who completed the study demonstrated a significant increase in weekday sleep duration and were less likely to engage in negative prior bedtime activities. In addition, 40% of those who completed baseline and post-intervention assessments noticed improvements in their sleep quality. Conclusion: These findings suggest that a brief online program is beneficial in improving sleep behaviors among college and could be a scalable approach to addressing current sleep issues and preventing future sleep problems in college students.

The profile of secondary metabolites occurring in apple cuticular layer is not only characteristic for particular apple cultivar, but also dynamically reflects various external factors in growing environment. In this study, the possibility to authenticate apple samples based on analysis of their cuticular layer extracts was investigated. Ultra-high-performance liquid chromatography coupled to high resolution tandem mass spectrometry (UHPLC-HRMS/MS) was employed for obtaining metabolomic fingerprints. In total, 274 authentic apple samples, four cultivars harvested within the seasons 2020 to 2022 in the Czech Republic and Poland were analysed. The generated complex data processed by univariate and multivariate statistical methods enabled to build classification models for discrimination of apple cultivars as well as their geographical origin. The models showed very good performance in differentiation of Czech and Polish samples for three of four cultivars: ‘Gala’, ‘Golden Delicious’ and ‘Idared’, moreover, the validity of the models was verified over harvest seasons. The diagnostic markers, besides metabolites of triterpene biosynthetic pathway, mainly represented wax esters. ‘Jonagold’, which is known to be susceptible to mutations, was the only cultivar for which the unambiguous classification of geographical origin was not possible.

Superior fiber quality is one of the most important objectives in cotton breeding. To detect the genetic basis underlying fiber quality, an F2 population containing 413 plants was constructed by crossing Jifeng 914 and Jifeng 173, both of which have superior fiber quality, with Jifeng 173 being better. Five fiber quality traits were investigated in the F2, F2:3, F2:4, and F2:5 populations. Quantitative trait loci (QTL) mapping was conducted based on a high-density genetic map containing 11,488 single nucleotide polymorphisms (SNPs) and spanning 4,202.12 cM in length. Transgressive segregation patterns and complex correlations in the five tested traits were observed. A total of 108 QTLs were found, including 27 for fiber length (FL), 16 for fiber strength (FS), 24 for micronaire (MC), 17 for fiber uniformity (FU), and 24 for fiber elongation rate (FE). Chromosome A7 contained 12 QTL, ranking the first. No QTL was found on chromosome D1 and D11. Each QTL contributed 1.98%–21.45% to the phenotypic variation (PV), including 13 major effect QTLs that contributed more than 10% toward PV. Two QTLs could be repeatedly detected in three populations, including qFL-D3-2 in F2, F2:4, and F2:5 with 9.18%–21.45% of PV, qFS-A11-1 in F2:3, F2:4 and F2:5 with 6.05%–10.41% of PV. Another seven stable QTLs could be detected in two populations, including four major effect QTLs: qFL-A12-3, qFS-D10-2, qMC-D6-2, and qMC-D8-1. Fourteen QTL-overlapping regions were found, which might explain the complex correlations among the five phenotypic traits. Four regions on chromosome A11, D3, D6, and D10 covered by both stable and major effect QTLs are promising for further fine mapping. The genomic regions of the two QTLs detected in three populations and the four major effect QTLs contain 810 genes. Gene functional analysis revealed that the annotated genes are mainly involved in protein binding and metabolic pathways. Fifteen candidate genes in the qFL-D3-2 region are highly expressed in fiber or ovules during fiber initiation, elongation, secondary cell wall thickening, or maturation stages. qRT-PCR revealed that Ghir_D03G005440.1 and Ghir_D03G011310.1 may play a role in promoting fiber initiation, Ghir_D03G006470.1 may be beneficial for promoting fiber elongation. This study provides more information for revealing the molecular genetic basis underlying cotton fiber quality.

Currently there are fewer depth models applied to pepper picking detection, while the existing generalized neural networks have problems such as large model parameters, long training time, and low model accuracy.In order to solve the above problems, this paper proposes a Yolo-chili target detection algorithm for chili pepper detection. First, the classical target detection algorithm yolov5 is used as a benchmark model, and an adaptive spatial feature pyramid structure combining the attention mechanism and the idea of multi-scale prediction is introduced to improve the model's detection effect on occluded peppers and small target peppers. Secondly, a three-channel attention mechanism module is introduced to improve the algorithm's long-distance recognition ability and reduce the interference of redundant testers. Finally, the quantized pruning method is used to reduce the model parameters and realize the lightweight processing of the model. Applying the method to the homemade chili pepper dataset, the AP value of chili pepper reaches 93.11%; the accuracy rate is 93.51% and the recall rate is 92.55%.The experimental results show that yolo-chili is able to achieve accurate and real-time pepper detection under complex orchards.

The temporary immersion system bioreactor named GreenTray®[2], [3]presents advantages over the existing ones. Firstly, there is no need to use forceps to move the shoots or plantlets in or out of the recipient, neither the use of scalpel to divide them. Secondly, the basis of the shoot can remain in the GreenTray® and can sprout again in several cycles of growth. These two characteristics reduce the costs in the process of micropropagation. Besides, shoots or plantlets development is enhanced by the aeration of the recipient, thus enriching with CO2 the recipient atmosphere. The chapter describes and provides images and values of interest in (1) the micropropagation process of some commercial Prunus or Pyrus rootstocks; (2) the plantlet growth under autotrophic conditions; and (2) the inoculation of plants with pathogens that reproduce in vitro the symptoms observed in vivo, using the GreenTray® bioreactor.

The aim of this retrospective study was to compare the clinical outcomes of treating isolated surgical neck fractures of the humerus using either the intramedullary nail or the MIROS (Minimally Invasive Reduction and Osteosynthesis System®) system. The study included 42 patients who underwent surgical treatment at the Polyclinic from January 2014 to June 2020. The results indicated that both treatments were effective; however, the MIROS system exhibited a higher complication rate. Intramedullary nailing was more reliable, thus recommended as the primary treatment method. This study underscores the importance of selecting the appropriate fixation technique to minimize complications and enhance patient outcomes.

Aiming at the problems of inaccurate segmentation of long object and information loss of small object in real-time semantic segmentation algorithm, this paper proposes a lightweight multi-branch real-time semantic segmentation network based on BiseNetV2. The new auxiliary branch makes full use of spatial details and context information to cover the long object in the field of view. Meanwhile, in order to ensure the inference speed of the model, the asymmetric convolution is used in each stage of the auxiliary branch to design a structure with low computational complexity. In the multi-branch fusion stage, the alignment and fusion module is designed to provide guidance information for deep and shallow feature mapping, so as to make up for the problem of feature misalignment in the fusion of information at different scales, and thus reduce the loss of small target information. In order to further improve the model’s awareness of key information, a global context module is designed to capture the most important features in the input data. The proposed network uses NVIDIA GeForce RTX 3080 Laptop GPU experiment, on the road street view data set Cityscapes and CamVid average occurring simultaneously ratio reached 77.1% and 78.4% respectively, with running speed of 127 frames/s respectively and 112 frames/s. The experimental results show that the proposed algorithm can achieve real-time segmentation and improve the accuracy significantly, showing good semantic segmentation performance

Excess nitrogen in agricultural drainage poses a serious threat to the water quality safety of the Yellow River basin. Utilizing aquatic plants to modify the rhizosphere microbial community structure and facilitate nitrogen transformation is a crucial strategy for mitigating regional water eutrophication. Our results revealed that the denitrification rate (DR), dissimilatory nitrate reduction to ammonium rate (DNRAR) and nitrogen fixation rate (NFR) of rhizosphere sediments exhibited a significant increase in artificially cultivated ditch. Compared with those in natural ditches, the richness of the bacterial community and the relative abundances of Bacteroidota, Verrucomicrobiota, Firmicutes, Anaeromyxobacter and Geobacter, which are involved mainly in the nitrogen cycle, in the rhizosphere sediments of artificially cultivated ditch were significantly greater due to improvements in environmental conditions. In artificially cultivated ditch, the dominant functional genes affecting DRNARs in the rhizosphere sediments of P. australis were nrfC and nrfA, while DRs were driven mainly by norB and napA, which were influenced by the nitrogen and carbon levels; and the dominant functional genes affecting NFRs in the rhizosphere sediments of T. orientalis were nifD, nifK and nifH. Our results provide a scientific basis for the use of aquatic plants for mitigating excess nitrogen levels in agricultural drainage.