Healthy Limb Research Articles

Intralimb Coordination Pattern of the Lower Limbs in Male Athletes With Allograft and Autograft Anterior Cruciate Ligament Reconstruction During Landing

Background and Objectives: Two common choices exist for anterior cruciate ligament (ACL) reconstruction, autograft and allograft. Hamstring tendon autografts and soft-tissue allografts are commonly used for ACL reconstruction. The outcomes between these two grafts are controversial. This research aims to quantify and compare lower limb joint coordination between two ACL reconstruction graft options and healthy individuals. Methods: Sixty-one athletes were enrolled after ACL reconstruction surgery (allograft, n=22; autograft, n=18). Furthermore, twenty-one healthy athletes were considered in the control group. The inclusion criteria included unilateral anterior cruciate ligament reconstruction surgery with allograft and autograft methods, male athletes with a minimum of 9 months and a maximum of two years since their surgery, successfully passing a series of quadriceps and hamstring strength tests and distance jumping before entering sports-specific activities under the supervision of a sports physiotherapist, and returning to pre-injury sports activities. Results: Autograft was not statistically different from matched healthy limbs in terms of joint coordination variability and magnitude (P>0.05). However, the magnitude of joint coordination was superior to the allograft group compared to the autograft reconstructed ACL (P<0.05). Conclusion: Although our result reported no significant difference between groups in joint coordination variability, having an insight into coordinative function after ACL reconstruction will help develop postoperative rehabilitation programs as well as minimize the re-injury risk among patients. We also suggest that scholars should conduct more robust trials with valid research designs to control the results of ACL reconstruction comparison with autograft and allograft.

Modeling, Simulation, and Kinematic Validation of Transfemoral Prosthetic Mechanism With Ankle Varus–Valgus Characteristic

Abstract Inspired by the kinesiology of human bionic joints, a transfemoral prosthetic mechanism based on a functional structure of parallel mechanism is developed for the transfemoral amputees. The walking interactive simulation is implemented based on human-prosthesis modeling to verify the kinematics of the designed prosthetic mechanism, as well as to explore compatibility between the amputees and prosthesis. Then, simulation-based prosthetic optimization is performed to pursue an optimized human-prosthesis model with economic metabolic consumption while eliminating compatibility errors including the joints' misalignment error between the affected limb and healthy limb, and the assembly error between human and prosthesis, so that the potential physical health problems can be avoided efficiently. This method is valuable for the optimal design of interactive rehabilitation robots. Finally, a developed proportional-integral-derivative-based (PID-based) finite-state machine (FSM) strategy is used, and the kinematic validation is carried out. The results show that the designed prosthesis possesses ankle varus–valgus characteristic, and it has a high human-like motion accuracy due to the FSM control can track prosthetic motion in each gait event. What's more, the prosthetic optimization can be an efficient method to enhance the biomechanical performance of human-prosthetic model so that the amputees have a more natural and symmetry gait.

Effect of groove splint fixation on early swelling and blood flow velocity of the injury limb in elderly patients with distal radius fractures

To observe the effects of groove splint fixation on early hand swelling, blood flow velocity, and clinical function in elderly patients with distal radius fractures. Between March 2021 and February 2022, 64 patients of unilateral closed distal radius fractures were treated with manual reduction and external fixation with splints. There were 10 males and 54 females, the age ranged from 60 to 78 years old, with an average age of (67.7±4.7) years old. According to the order of admission, the patients were divided into the groove splint group and the conventional splint group, with 32 cases in each group. In the groove splint group, there were 4 males and 28 females, with an average age of (68.6±4.8) years old. There were 13 patients with left-sided fractures, and 19 patients with right-sided fractures, with 22 cases classified as AO type A and 10 cases as AO type C. The mean time from injury to treatment was 3.0 (2.0, 4.0) h. In the conventional splint group, there were 6 males and 26 females, with an average age of (66.9 ± 4.4) years old. There were 17 patients with left-sided fractures and 15 patients with right-sided fractures, with 20 cases classified as AO type A and 12 cases as AO type C. The mean time from injury to treatment was 3.0 (2.0, 5.0) h. After manual reduction, patients were treated with groove splint or conventional splint. Swelling, assessed by the difference in limb circumference between the injured and healthy limbs, was measured at 1, 3, 7, and 14 days post-treatment. Blood flow velocities in the superficial palmar arch and dorsal metacarpal veins were measured at 1, 3, and 7 days post-treatment. Radiographic evaluations of radial styloid height, palmar tilt, and ulnar variance were performed preoperatively and 3 months post-treatment. Functional outcomes were assessed using the DASH (Disabilities of the Arm, Shoulder, and Hand) score 3 and 12 months post-treatment. Statistical analyses were conducted to compare the outcomes between the two groups. All 64 patients were followed up for the least 12 months. The swelling value of the palm in the groove splint group [(1.897±0.071) cm, (1.200±0.169) cm, (0.994±0.085) cm] was significantly improved compared to the conventional splint group[(2.283±0.268) cm, (1.893±0.269) cm, (1.183±0.126) cm] on days 3, 7, and 14 days posttreatment, with a statistically significant difference (P<0.001). On the first and third day after splint fixation, the difference in blood flow velocity of the superficial palmar arch in the groove splint group(0.017±0.009), (0.018±0.011) L·min-1 were lower than that in the conventional splint group(0.023±0.011), (0.025±0.013) L·min-1, with statistical significance (P<0.05). On the 3rd and 7th days, the difference was not statistically significant (P>0.05). Comparison of blood flow velocity differences between the dorsal metacarpal vein and the two groups showed no statistically significant difference on the first day after splint fixation (P>0.05). On the 3rd and 7th days, the blood flow velocity difference between the groove splint group[(0.037±0.019), (0.021±0.013) L·min-1] decreased compared to the conventional splint group[(0.062±0.033), (0.037±0.022) L·min-1], and the difference was statistically significant (P<0.05). There was no statistically significant difference in the palm angle, ulnar deviation angle, and radius height of the distal radius before and after reduction (P>0.05). The DASH score showed a statistically significant difference at follow-up 3-month[(6.1±2.8) scores vs (8.2±3.7) scores] , P<0.05, but no statistically significant difference at follow-up 12-month (P>0.05). Fixing distal radius fractures with groove splints in the early stage can reduce the impact on the blood flow velocity of the superficial palmar arch and dorsal palmar vein, reduce venous reflux obstruction and swelling of injury limb, alleviate wrist and finger joint stiffness, and improve early clinical efficacy of the affected limb. However, it has no significant impact on clinical function one year after injury.

Changes in Y-Balance Test Scores During Months 4, 5, and 6 of ACL Reconstruction Rehabilitation.

The anterior cruciate ligament (ACL) is well researched since injuries typically result in lengthy recoveries and rehabilitation periods until athletes can return to full activity. Although a large body of literature on the early and late stages of rehabilitation following ACL reconstructive (ACLR) surgery exists, less is known regarding the mid-phase of ACL rehabilitation and healthy versus injured limb differences in functional testing during this stage. The purpose of this study is to determine if Y-Balance Test (YBT) scores obtained during the mid-phase of ACLR rehabilitation change over months 4, 5, and 6. Case Series. Research laboratory. Patients or Other Participants: A total of 27 participants (17 females; 18.96±3.02 years (range 15-24); 173.63±10.29cm; 72.55±17.83kg) who sustained a unilateral ACL injury, experienced no episodes of instability or knee giving away, had not suffered a previous ACL injury, and expressed a desire to return to sport at the end of rehabilitation came in once a month following ACLR to participate in a battery of tests. YBT scores in the anterior, posterolateral (PL), and posteromedial (PM) directions in the healthy and reconstructed limbs. A main effect for limb was observed for the anterior (Healthy: m4: 78.8cm±5.8, m5: 79.5cm±5.2, m6: 79.4±5.8; Reconstructed: m4: 77.2±5.9, m5: 78.5±5.1, m6: 78.1±6.4, p=0.023) and PM (Healthy: m4: 80.0cm±8.7, m5: 81.0cm±9.1, m6: 82.9cm±8.9; Reconstructed: m4: 79.3cm±6.8, m5: 79.4cm±8.2, m6: 81.1cm±8.5, p=0.013). directions indicating that the reconstructed limb performed worse than the healthy limb. A main effect for time was observed for the PL direction (Healthy: m4: 78.8cm±5.8, m5: 79.5cm±5.2, m6: 79.4cm±5.8; Reconstructed: m4: 77.2cm±5.9, m5:78.5cm±5.1, m6: 78.1cm±6.4, p=0.023). The YBT measured improvement in the PL direction across time in the reconstructed limb. In the PM and anterior directions, the YBT did not measure these same improvements across this period.

Anatomic Study and Clinical Application of C7 Nerve Transfer Surgery via the Anterior Vertebral Approach for Central Upper Limb Spastic Paralysis

Objective: To explore the anatomic characteristics of C7 nerve localization, course, and length during cross-transfer surgery of the C7 nerve through the anterior vertebral approach and investigate the feasibility, safety, and clinical efficacy of C7 nerve transfer surgery through the anterior vertebral approach for the treatment of central upper limb spastic paralysis. Methods: Four fresh-frozen adult head and neck samples were selected. C7 nerve transfer surgery was simulated through the anterior vertebral approach. The vertical distance between the C7 nerve and the medial edge of the clavicle, the length of the C7 nerve, and the shortest distance of C7 nerve transfer required through the anterior vertebral approach were measured. This was a retrospective analysis of the clinical data of 2 patients with central upper limb spastic paralysis after C7 nerve transfer surgery at Northern Jiangsu People’s Hospital affiliated with Yangzhou University. The patients were all female, aged 50 to 51 years, with upper limb paralysis on the affected side. The muscle strength was grade 0 or grade 1, and the muscle tension was relatively high. Both patients underwent C7 nerve transfer surgery through the anterior vertebral approach. Upper limb sensation and motor function were observed. Results: Bilateral C7 nerves can be fully exposed and located through the anterior vertebral approach. The C7 nerve runs between the anterior and middle scalene muscles, with a vertical distance of 1.7 to 2.5 (2.1±0.3) cm from the inner edge of the clavicle. The length of the C7 nerve is 5.6 to 6.8 (6.4±0.5) cm, and the shortest distance of C7 nerve transfer through the anterior vertebral approach is 4.8 to 5.7 (5.3±0.4 cm). Two patients with central upper limb paralysis successfully underwent C7 nerve transfer surgery using the anterior vertebral approach. Two patients had normal motor function in the healthy upper limb after surgery but experienced pain and numbness in the healthy upper limb. Both patients recovered within 1 month. Two patients experienced significant relief of spasticity symptoms in the affected upper limb. One patient was followed up for 15 months, and, at the last follow-up, sensation in the affected upper limb was normal, with proximal muscle strength at level 3 and distal muscle strength at level 2. Another patient was followed up for 11 months, and at the last follow-up, sensation in the affected upper limb was normal, with proximal muscle strength at level 1+ and distal muscle strength at level 1. Conclusion: For central upper limb spastic paralysis, C7 nerve transfer surgery through the anterior vertebral approach is safe and feasible and is a good treatment option. Related anatomic research can effectively guide clinical surgery and assist in locating the C7 nerve, and incising the musculus longus colli can shorten the distance of C7 nerve transfer.

Lymphatic Mapping with Multi-Lymphosome Indocyanine Green Lymphography in Legs with Lymphedema

AbstractIt is observed that the locations of the most functional lymphatic vessels in the lymphedematous limbs can differ significantly from those in healthy limbs. The aim of this study was to elucidate the lymphatic map of lymphedematous limbs. We retrospectively analyzed 59 patients (118 limbs) with lower limb lymphedema. Fifty-five were women and four were men. The mean age and duration of lymphedema was 62.4 and 7.7 years, respectively. For the lateral thigh lymphosome, we injected indocyanine green (ICG) at the lateral knee and measured the distance (Dt) between the anterior superior iliac spine (ASIS) and the point where the lymphatic vessels crossed the reference line (the line connecting the ASIS and the patellar center). For the lateral calf lymphosome, we injected ICG at the lateral ankle and measured the distance (Dc) between the inferior patellar border and the point where the lymphatic vessels crossed the reference line (the anterior border of the tibia). In the lateral thigh, the mean Dt was 30.4 ± 0.6 cm (range, 0–41 cm) and the distribution peaked at approximately 30 cm from the ASIS. In the calf, the mean Dc was 13.1 ± 0.9 cm (range, −11 to 32 cm). The distribution of lymphatic vessel locations was highly variable. We could establish the lymphatic map in the lymphedematous legs. The distribution of lymphatic vessels in the thigh and lower legs had one and two peaks, respectively.

Evaluation of the effect of vascularized fibula graft harvesting on coronal plane alignment and functional outcomes of the lower limb

Recent studies on fibular osteotomy for varus gonarthrosis and possible subsequent biomechanical changes have attracted increasing attention to the topic. Existing studies have focused mainly on proximal fibular osteotomy with short follow-up periods. The aim of this study was to investigate changes in the alignment of the coronal plane of the ankle and knee joints in patients who underwent vascularized fibula graft harvest (VFGH). The evaluation was based on functional outcomes and radiological measurements.In the comparison between the VFGH side and the contralateral side, no significant differences in the knee inclination (KI) or talar inclination (TI) angle, knee medial clear space (K-MCS) or ankle medial clear space (A-MCS) distance were noted. However, a significant difference in the hip knee (HKA) angle was observed between the operated and nonoperated sides (0.3° ± 1.8° and 1.5° ± 1.9°, respectively [p = 0.019]). Statistically significant differences in both the knee society score (KSS) and the AOFAS scores were found between the ipsilateral donor limb and the contralateral healthy limb. Although the contralateral healthy side had better clinical scores than the VFGH side, the outcomes of the VFGH side were still satisfactory or excellent.

A Study of the Effect of the Difference in Energy Stored in Two Prosthetic Feet Made of Carbon Fiber Amputated Below the Knee on the Efficiency of Walking

ESAR feet are prosthetic feet with carbon fiber parts that store mechanical energy while standing and release it during propulsion. It is believed to reduce the metabolic energy needed for walking, and to promote the economy of walking. However, there is little scientific evidence to support this claim. This study aimed to compare the energy storage properties of two prosthetic feet made of carbon fiber using the P-Walk, G-Walk, and Podium devices developed for gait analysis, which is a systematic examination of human movement, enabling phasing, estimation of musculoskeletal performance, and determination of kinematic and motor parameters. The amount of energy was calculated for each of the feet using the load deflection test, and the results showed that the new artificial foot with an energy of 6.186 joules showed a great improvement in the results of the tests compared to the old artificial foot with an energy of 3.403 joules. The Podium device tests showed a significant improvement in walking patterns and pressure distribution after using a new foot. The pressure distribution became almost equal on both sides, and the angular deviation of COP decreased from -7 to 1.3 degrees. Ground reaction force vector tilt results also improved, with a body angle of 0 degrees and inclination varying slightly depending on the tibiofemoral angle for males. P-Walk results reveal left-sided static test pressure distribution, exposing amputees to osteoarthritis risk and revealing lack of confidence in prosthetic foot. After use the new prosthetic foot, amputees press more on right foot, indicating balance restoration. The G-Walk device shows the effectiveness of both healthy left and prosthetic foot when walking on an amputated right leg when use the new prosthetic foot. The amputated side's performance is similar to a healthy limb, with minimal difference and within normal limits. Walking cadence and speed values are within normal ranges, while stride length and step length are outside normal ranges for both sides. Obliquity results show a small difference in pelvic angles due to weak pelvic muscles, but these are close to standard values for prosthetic foot use. The amputee's opinions about the evaluation of the new prosthetic foot were good when using the T-score by 61.0 with a rate of 86.4%. It was a significant improvement compared to the old foot with an evaluation of 53.6 by 63.9%.

Effects of different slopes on hip and ankle biomechanics of replaced and non-replaced limbs of patients with total knee arthroplasty during incline ramp walking

Although knee biomechanics has been examined, hip and ankle biomechanics in incline ramp walking has not been explored for patients with total knee arthroplasty (TKA). The purpose of this study was to investigate the hip and ankle joint kinematic and kinetic biomechanics of different incline slopes for replaced limbs and non-replaced limbs in individuals with TKA compared to healthy controls. Twenty-five patients with TKR and ten healthy controls performed walking trials on four slope conditions of level (0°), 5°, 10° and 15° on a customized instrumented ramp system. A 3x4 (limb x slope) repeated analysis of variance was used to evaluate selected variables. The results showed a greater peak ankle dorsiflexion angle in the replaced limbs compared to healthy limbs. No significant interactions or limb main effect for other ankle and hip variables. The peak dorsiflexion angle, eversion angle and dorsiflexion moment were progressively higher in each comparison from level to 15°. The peak plantarflexion moment was also increased with each increase of slopes. Both the replaced and non-replaced limbs of patients with TKA had lower hip flexion moments than the healthy control limbs. Hip angle at contact and hip extension range of motion increased with each increase of slopes. Peak hip loading-response internal extension moment increased with each increase in slope and peak hip push-off internal flexion moment decreased with each increase of slope. Our results showed increased dorsiflexion in replaced limbs but no other compensations of hip and ankle joints of replaced limbs compared to non-replaced limbs and their healthy controls during incline walking, providing further support of using incline walking in rehabilitation for patients with TKA.

Surgical accidents and postoperative complications of recurrent shoulder dislocation treated by suture button fixation with bone occlusion

To summarize the surgical accidents and postoperative complications of the treatment of recurrent shoulder dislocation by suture button fixation and bone occlusion, and to provide clinical reference. The clinical data of 16 patients with recurrent shoulder dislocation treated with modified arthroscopic Latarjet suture button fixation and bone occlusion between July 2017 and April 2023 were retrospectively analyzed. Among them, 15 were male and 1 was female. The age ranged from 16 to 45 years, with an average of 26 years. Admission examination showed the range of motion of shoulder joint was normal; the shoulder joint fear test was positive; En-face CT scan measured 10%-20% of the glenoid defects, averaging 13.4%; and MRI examination revealed bone Bankart injury. The disease duration ranged from 2 to 20 years, with an average of 7.1 years. The shoulder joint was dislocated 8- 45 times, with an average of 17.4 times, and the shoulder joint was unstable. The occurrence of surgical accidents and postoperative complications as well as corresponding measures and outcomes were recorded. All the incisions healed by first intention without any complications such as incision infection or vascular injury. All 16 cases were followed up for an average of 3.6 years (range, 1-7 years), and no shoulder redislocation occurred. Four types of intraoperative surgical accidents and two types of postoperative complications occurred in the early stage of implementation of the technique. Intraoperative surgical accidents included 1 case of difficulty in passing subscapular muscle through coracotomy with large size, which was treated with exchange rod or finger through subscapular muscle split; 2 cases of coracoidal process fracture, of which 1 case was treated conservatively, and the other case was sutured to the base of tendon and fixed through tunnel; 1 case of glenoid fracture occurred in the glenoid tunnel, which was fixed with knot-free anchors; the posterior loop plate fixation was abnormal in 2 cases, of which 1 case was re-fixed and the other case was renovated. Postoperative complications included coracoid bone mass displacement in 1 case, conservative biceps rehabilitation was given to avoid premature external rotation; 1 case of radial nerve injury of healthy upper limb and musculocutaneous nerve injury of affected side was given oral medication and physiotherapy. The above conditions recovered well after corresponding treatment. Suture button fixation with bone occlusion is a safe method for the treatment of recurrent shoulder dislocation. Careful operation should be performed during coracoid interception and glenoid tunnel drilling, especially in the fixation process.

Patient autonomy in the era of the sustainability crisis.

In the realm of medical ethics, the foundational principle of respecting patient autonomy holds significant importance, often emerging as a central concern in numerous ethically complex cases, as authorizing medical assistance in dying or healthy limb amputation on patient request. Even though advocates for either alternative regularly utilize prima facie principles to resolve ethical dilemmas, the interplay between these principles is often the core of the theoretical frameworks. As the ramifications of the sustainability crisis become increasingly evident, there is a growing need to integrate awareness for sustainability into medical decision-making, thus reintroducing potential conflict with patient autonomy. The contention of this study is that the ethical standards established in the 20th century may not adequately address the challenges that have arisen in the 21st century. The author suggests an advanced perception of patient autonomy that prioritizes fostering patients' knowledge, self-awareness, and sense of responsibility, going beyond a sole focus on their intrinsic values. Empowering patients could serve as a tool to align patient autonomy, beneficence, and the aim to reduce resource consumption.

Implications of Stabilometric Assessment in Determining Functional Deficits in Patients with Severe Knee Osteoarthritis: Observational Study.

Background: Osteoarthritis is one of the most frequent joint disorders in the world. The specialists in the field strongly support the role of physical exercise as a key component in the holistic management of arthrosis. The aim of the current study was to identify and assess the functional deficit of these patients and to identify means to alleviate it through pre-surgery physiotherapy programs. Methods: The study was conducted on two samples of patients: a witness sample, encompassing 126 subjects without pathologies at the level of their lower limbs, and a study sample, formed of 116 subjects diagnosed with severe gonarthrosis with total knee arthroplasty indication. The assessment protocol was accomplished with the GPS 400 stabilometric platform. Results: The barycenter differences within the support polygon, recorded for the two samples within sagittal deviation, emphasize that the barycenter shifting mainly towards the healthy lower limb will demand, from the individual, more intense rebalancing postural reactions that will place the center-of-gravity projection in the sagittal plane, closer to the central area of the support polygon. Conclusions: In the case of gonarthrosis and other joint disorders, the use of functional testing to assess body weight distribution and center-of-gravity imbalances represents a promising direction in the research on and management of these disorders, providing essential information for functional diagnosing and thus enabling the elaboration and monitoring of individualized functional rehabilitation plans.

Assessment of the Effectiveness and Safety of Wheelchair Use Training for Patients with Hemiparesis

INTRODUCTION. The rationale of the research is defined by the large number of patients with hemiparesis, unable to restore an upright posture and in need of training to use a wheelchair. AIM. To present the methodology of wheelchair training of patients with hemiparesis. MATERIALS AND METHODS. We observed 30 patients with severe hemiparesis during wheelchair training. Examination included assessment of clinical, neurological, and mental status (MMSE — Mini-Mental State Examination), testing of limb muscle strength according to Lovett’s scale modified by L.D. Potekhin, level of sitting function compensation assessment, wheelchair skills (Wheelchair Skills Test). Each patient attended 10 wheelchair training sessions and related physical therapy (PT) sessions, with PT classes preceding the wheelchair training sessions and practicing the wheelchair-using movements required in the wheelchair training sessions. Patients controlled the wheelchair using only healthy limbs. RESULTS. At the moment of admission, 14 patients were not able to use wheelchair independently; 16 patients were able to use wheelchair to varying degrees. As a result of the sessions, the muscle strength of healthy limbs increased; statistically significant improvement in sitting and wheelchair skills was noted. None of the patients who scored 10 for MMSE test improved their wheelchair skills. CONCLUSION. Persons with severe hemiparesis learn to use the wheelchair with the help of healthy limbs. Physical therapy sessions precede wheelchair training and form the movements necessary for learning to use the wheelchair.

Single Nuclear Analyses Reveal Compromised Integrity of Neuromuscular Junction Myonuclei Following Joint Injury

The neuromuscular junction is an essential structure that links electrical signals from the nervous system to contraction of skeletal muscle. The post synaptic region of a muscle cell is maintained by a subset of specialized myonuclei responsible for clustering of post synaptic structural proteins and acetylcholine receptors. Disruptions in the transcriptional program of these myonuclei may result in ineffective myofiber recruitment, slowed force generation, and muscle weakness. We have shown that traumatic joint injury results in protracted deficits in muscle strength and power, but the peripheral mechanistic underpinnings remain unclear. Phenotypically, muscle pathology occurring after traumatic joint injury resembles that of neuromuscular destabilization, yet molecularly, this remains uninvestigated. Therefore, we hypothesize that disruption of neuromuscular regulatory gene programs and destabilization of the neuromuscular junction following joint injury will result in rapid muscle functional deficits. Human muscle biopsies were obtained from the vastus lateralis of anterior cruciate ligament (ACL) injured and healthy limbs of 26 participants. Injured biopsies were taken before and 7 days following reconstruction surgery. Bulk tissue RNA-seq analysis was performed on all participants and single-nucleus RNAseq (snRNAseq) was performed on a subset of participants. Briefly, for snRNAseq, muscle was dounce homogenized, filtered, and nuclei isolated via fluorescent activated cell sorting. Following sequencing, CellRanger output files containing count matrices were filtered, and analyzed using Partek Flow and Seurat. Biopsy sections were processed for histochemistry to analyze fiber size and motor end plate innervation. All participants underwent strength testing on a biodex to assess isometric quadriceps torque and rate of torque development. RNA sequencing displayed &gt;3 fold upregulation of CHRNA1 (P&lt; 0.001) after injury alone and &gt;18 fold upregulation 7 days following reconstruction surgery (P&lt; 0.001). This was accompanied by a host of other neuromuscular regulatory genes including HDAC4 (P&lt; 0.001), GDNF (P&lt; 0.001), and RUNX1 (P&lt; 0.001). Single nucleus sequencing revealed a complete disappearance of neuromuscular junction regulatory myonuclei following reconstruction surgery coupled with delocalization of acetylcholine receptor expression. These findings were confirmed with fluorescent in situ hybridization of CHRNA1 RNA on biopsy sections. Functionally, CHRNA1 RNA expression strongly correlates with deficits in rate of torque development following injury (R^2 = 0.85, P&lt; 0.001). Our results display rapid remodeling of the postsynaptic neuromuscular junction following joint injury that underscores sustained deficits in strength and power. Interventions targeting the preservation of peripheral innervation may be warranted to enhance outcomes following joint injury. R01AR072061. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

An Innovative Non-Invasive Method for Early Detection and Monitoring of Acute Compartment Syndrome.

Background: Acute compartment syndrome is a major surgical emergency with complex pathophysiology and a highly unpredictable pattern of evolution. We hypothesized that the onset of acute compartment syndrome of the leg or forearm is associated with variations in the surface temperature of the distal segment (foot or hand) with a distinct pattern, which acts as an early warning sign. Materials and Methods: We developed a monitoring device that consists of two thermic sensors attached to a modular limb splint, which continuously measure the temperature difference between the proximal and distal regions of the limb (i.e., arm-hand, thigh-foot). Firstly, we investigated both the arm-hand and thigh-foot temperature gradients of hospitalized patients' healthy limbs (43 patients, 56 upper limbs, 64 lower limbs) in order to establish a baseline. Secondly, we examined the correlation between the thermic gradients and intracompartmental pressure values in compartment syndrome limbs (20 patients, 6 upper limbs, 14 lower limbs). Results: For the control group, the mean values for the normal limb thermic gradients were -0.17 °C for the upper limbs. and 0.03 °C for the lower limbs. In the impending compartment syndrome group (defined by intracompartmental pressure values), the mean index was -0.38 °C. In the fully developed compartment syndrome group, the mean value was 4.11 °C. Discussions: Analysis was performed using the ANOVA one-way statistical method. This showed significant differences between the compartment syndrome group and the impending and control groups. A decreasing trend in the thermic gradient in patients with impending compartment syndrome compared with the control group was noted. Conclusions: The thermic gradient of limbs presenting signs of impending compartment syndrome decreases as a result of the increased temperature of the distal segment. This pattern can be used as an early diagnostic method for acute compartment syndrome. This technique is non-invasive and bears no risk to the patient, allowing facile continuous monitoring during immobilization.

Soft Robotic Bilateral Rehabilitation System for Hand and Wrist Joints

Upper limb functionality is essential to perform activities of daily living. It is critical to investigate neurorehabilitation therapies in order to improve upper limb functionality in post-stroke patients. This paper presents a soft-robotic bilateral system to provide rehabilitation therapy for hand and wrist joints. A sensorized glove that tracks finger and wrist joint movements is worn on the healthy limb, which guides the movement of the paretic limb. The input of sensors from the healthy limb is provided to the soft robotic exoskeleton attached to the paretic limb to mimic the motion. A proportional derivative flow-based control algorithm is used to perform bilateral therapy. To test the feasibility of the developed system, two different applications are performed experimentally: (1) Wrist exercise with a dumbbell, and (2) Object pick-and-place task. The initial tests of the developed system verified its capability to perform bilateral therapy.

Association Between Patellar Tendon Abnormality and Land-Jump Biomechanics in Male Collegiate Basketball Players During the Preseason.

Patellar tendinopathy is a degenerative condition that predominantly affects jumping athletes. Symptoms may be subtle or nonexistent at preseason, but structural abnormalities may be present. Assessing patellar tendon abnormality (PTA) through magnetic resonance imaging (MRI) and ultrasound (US) and classifying symptoms using the Victorian Institute for Sport Assessment-Patellar tendon (VISA-P) may provide useful insights if combined with biomechanics measurements. To (1) assess whether land-jump biomechanical patterns are associated with clinically pertinent PTA as seen on imaging and through VISA-P scores and (2) model the contributing risk and accuracy of biomechanics to classify PTA and symptomatic observations. Cross-sectional study; Level of evidence, 3. A total of 26 National Collegiate Athletic Association Division I and II male basketball players (n = 52 limbs) were recruited during the preseason. We collected VISA-P scores, bilateral PTA through US and MRI morphology measurements, and bilateral 3-dimensional lower extremity kinematics and kinetics measurements from a land-jump test from an 18-inch-high (45.7-cm-high) box. Statistically, each limb was treated independently. The association of biomechanics with PTA and symptoms (VISA-P score <80) was tested with multivariate models and post hoc tests. Logistic regression modeled relative risk and accuracy of biomechanical variables to classify PTA and symptomatic limbs. There were 19 to 24 limbs with PTA depending on US and MRI measurements. Differences in hip and knee kinematic strategies and ground-reaction loads were associated with PTA and symptomatic limbs. Peak landing vertical ground-reaction force was significantly decreased (169 ± 26 vs 195 ± 29 %body weight; P = .001), and maximum hip flexion velocity was significantly increased (416 ± 74 vs 343 ± 94 deg/s; P = .005) in limbs with versus without PTA on imaging. Knee flexion at the initial contact was decreased in symptomatic versus healthy limbs (17°± 5° vs 21°± 5°, respectively; P = .045). Regression models classified PTA limbs and symptomatic limbs with 71.2% to 86.5% accuracy. Hip and knee maximum flexion velocity and vertical ground-reaction force variables were most common across models observing clinically pertinent PTA. Our findings suggested that functional kinematic and kinetic biomechanical strategies at the hip and knee were associated with PTA, identified on imaging, and symptomatic limbs.

Patient's Healthy-Limb Motion Characteristic-Based Assist-As-Needed Control Strategy for Upper-Limb Rehabilitation Robots.

The implementation of a progressive rehabilitation training model to promote patients' motivation efforts can greatly restore damaged central nervous system function in patients. Patients' active engagement can be effectively stimulated by assist-as-needed (AAN) robot rehabilitation training. However, its application in robotic therapy has been hindered by a simple determination method of robot-assisted torque which focuses on the evaluation of only the affected limb's movement ability. Moreover, the expected effect of assistance depends on the designer and deviates from the patient's expectations, and its applicability to different patients is deficient. In this study, we propose a control method with personalized treatment features based on the idea of estimating and mapping the stiffness of the patient's healthy limb. This control method comprises an interactive control module in the task-oriented space based on the quantitative evaluation of motion needs and an inner-loop position control module for the pneumatic swing cylinder in the joint space. An upper-limb endpoint stiffness estimation model was constructed, and a parameter identification algorithm was designed. The upper limb endpoint stiffness which characterizes the patient's ability to complete training movements was obtained by collecting surface electromyographic (sEMG) signals and human-robot interaction forces during patient movement. Then, the motor needs of the affected limb when completing the same movement were quantified based on the performance of the healthy limb. A stiffness-mapping algorithm was designed to dynamically adjust the rehabilitation training trajectory and auxiliary force of the robot based on the actual movement ability of the affected limb, achieving AAN control. Experimental studies were conducted on a self-developed pneumatic upper limb rehabilitation robot, and the results showed that the proposed AAN control method could effectively estimate the patient's movement needs and achieve progressive rehabilitation training. This rehabilitation training robot that simulates the movement characteristics of the patient's healthy limb drives the affected limb, making the intensity of the rehabilitation training task more in line with the patient's pre-morbid limb-use habits and also beneficial for the consistency of bilateral limb movements.

Effect of non-vascularized fibular harvest on the donor limb: radiological evaluation at a mean follow-up of twelve point eightyears.

The study is aimed at evaluating the long-term (at a minimum follow-up of 10years) impact of non-vascularized fibular harvest on the donor limbs. There were 27 donor limbs (n = 19 children) available for retrospective radiological review. The graft was obtained bilaterally in eight patients. The following parameters were evaluated in the follow-up radiographs: continuity/non-continuity of fibular regenerate, width of the regenerated fibula, distal fibular station, medial proximal tibial angle, posterior proximal tibial angle, lateral distal tibial angle (LDTA), anterior distal tibial angle, and tibia diaphyseal angulation (interphyseal angles). For analysis and comparisons, the donor limbs were compared to the healthy limbs (controls) of the children with unilateral harvest. Additionally, the impact of continuous and non-continuous fibular regeneration was separately analyzed. The mean child's age at the time of fibular harvest was fouryears. The mean follow-up was 12.8years. The fibula was found regenerated in continuity in 22 limbs of 15 children (81.5%). When analyzed as a combined group (both continuous and non-continuous fibular regenerations), all the donor limb radiological parameters matched those of healthy limbs except LDTA (p = 0.04). In the subgroup analysis between non-continuous and continuous fibulae, significant abnormalities were again obvious in LDTA (p = 0.0001). The non-continuous fibulae were significantly lesser in width. All limbs with non-continuous fibular regeneration manifested ankle valgus. The non-vascularized fibula emerged as a relatively safe procedure in the long term with minimal affections of the knee, ankle, or tibial anatomy when longitudinal integrity of fibula was restored. The non-regenerations of the fibula may be prone to developing ankle valgus.

Prokaryotic and eukaryotic skin microbiota modifications triggered by Leishmania infection in localized Cutaneous Leishmaniasis.

Cutaneous Leishmaniasis (CL) is a tropical disease characterized by cutaneous ulcers, sometimes with satellite lesions and nodular lymphangitis. Leishmania parasites, transmitted by sandfly vectors, cause this widespread public health challenge affecting millions worldwide. CL's complexity stems from diverse Leishmania species and intricate host interactions. Therefore, this study aims to shed light on the spatial-temporal distribution of Leishmania species and exploring the influence of skin microbiota on disease progression. We analyzed 40 samples from CL patients at three military bases across Colombia. Using Oxford Nanopore's Heat Shock Protein 70 sequencing, we identified Leishmania species and profiled microbiota in CL lesions and corresponding healthy limbs. Illumina sequencing of 16S-rRNA and 18S-rRNA genes helped analyze prokaryotic and eukaryotic communities. Our research uncovered a spatial-temporal overlap between regions of high CL incidence and our sampling locations, indicating the coexistence of various Leishmania species. L. naiffi emerged as a noteworthy discovery. In addition, our study delved into the changes in skin microbiota associated with CL lesions sampled by scraping compared with healthy skin sampled by brushing of upper and lower limbs. We observed alterations in microbial diversity, both in prokaryotic and eukaryotic communities, within the lesioned areas, signifying the potential role of microbiota in CL pathogenesis. The significant increase in specific bacterial families, such as Staphylococcaceae and Streptococcaceae, within CL lesions indicates their contribution to local inflammation. In essence, our study contributes to the ongoing research into CL, highlighting the need for a multifaceted approach to decipher the intricate interactions between Leishmaniasis and the skin microbiota.