Leg Position Research Articles

Mechanism of non-contact ACL injury: OREF Clinical Research Award 2021.

Anterior cruciate ligament (ACL) ruptures significantly impact athletes in terms of return to play and loss of long-term quality of life. Before the onset of this study, understanding the mechanism of ACL injury was limited. Thus, the primary focus of this manuscript is to describe our multi-faceted approach to uncovering the mechanism of noncontact ACL injury (NC-ACLI) with the goal of developing preventive strategies. The initial qualitative analysis of ACL injury events revealed most (70%) injuries involve minimal to no contact and occurr during landing or deceleration maneuvers in team sports with a minor perturbation before the injury that may disrupt the neuromuscular system leading to poor body dynamics. A series of quantitative videotape studies demonstrated differences in leg and trunk positions at the time of NC-ACLI in comparison to control subjects. Analysis of the faulty dynamics provoking NC-ACLI, especially the flat-footed landing component, supports the theory that an axial compressive force is the critical factor responsible for NC-ACLI. Our magnetic resonance imaging study demonstrated the NC-ACLI position was associated with a higher tibial slope, and joint contact occurring on the flat, anterior portion of the lateral femoral condyle versus the round, posterior aspect. Both anatomic conditions favor sliding (pivot shift) over rolling in the presence of an axial compressive force. Subsequent cadaveric studies supported axial compressive forces as the primary component of NC-ACLI. Both a strong eccentric quadriceps contraction and knee abduction moments may increase the compressive force at the joint thereby lowering the axial threshold to injury. This manuscript summarizes the NC-ACLI mechanism portion of the 2021 OREF Clinical Research Award.

Systematic Comparison of OWAS, RULA, and REBA Based on a Literature Review.

This study aimed to systematically compare three representative observational methods for assessing musculoskeletal loadings and their association with musculoskeletal disorders (MSDs): Ovako Working Posture Analysis System (OWAS), Rapid Upper Limb Assessment (RULA), and Rapid Entire Body Assessment (REBA). The comparison was based on a literature review without time limitations and was conducted on various factors related to observational methods. The comparisons showed that although it has a significant limitation of comprising only two classifications for the leg postures, (1) the RULA is the most frequently used method among the three techniques; (2) many studies adopted the RULA even in evaluation of unstable lower limb postures; (3) the RULA assessed postural loads as higher risk levels in most studies reviewed in this research; (4) the intra- and inter-reliabilities for the RULA were not low; and (5) the risk levels assessed by the RULA were more significantly associated with postural load criteria such as discomfort, MHTs and % capable at the trunk, and MSDs.

Extension of Dancer's Legs: Increasing Angles Show Motion.

Usain Bolt’s Lightning Bolt pose, one arm highly extended to one side, suggests action. Likewise, static pictures of animals, legs extended, show animation. We tested a new cue for motion perception—extension—and in particular extension of dancer’s legs. An experiment with pictures of a dancer finds larger angles between the legs suggest greater movement, especially with in-air poses and in lateral views. Leg positions graded from simply standing to very difficult front and side splits. Liking ratings (a small range) were more related to Difficulty ratings (a large range) than Movement ratings (a moderate range).

A kinematic model of a humanoid lower limb exoskeleton with pneumatic actuators

Purpose: Although it is well-established that exoskeletons as robots attached to the human body’s extremities increase their strength, limited studies presented a computer and mathematical model of a human leg pneumatic exoskeleton based on anthropometric data. Methods: By using Inertial Measurement Units a lower limb joint angles (hip, knee and ankle in sagittal plane) during walking and running were calculated. The geometric model of a human leg pneumatic exoskeleton was presented. Joint angle data acquired during experiments were used in the mathematical model. Results: The position and velocity of exoskeleton actuators in each phase of the movement were calculated using the MATLAB package (Matlab_R2017b, The MathWorks Company, Novi, MI, USA). Conclusions: The obtained results demonstrate the efficiency of the proposed approach that can be utilized to analyze the kinematics of pneumatic exoskeletons using the dedicated design process. The developed mathematical model makes it possible to determine the position of lower limb segments and exoskeleton elements. The proposed model allows for calculating the position of the human leg and actuators’ characteristic points

Theoretical analysis and experimental evaluation of vibration isolation system with broadband characteristic for laser tracker

High-energy synchrotron radiation source, as a large scientific device, is under construction in Beijing, China. This device is one of the fourth-generation synchrotron radiation sources with the highest brightness in the world. It will provide an important support platform for basic science and engineering science. As a kind of high-precision large-scale measurement equipment, laser tracker is used mainly in high-energy particle accelerator equipment installation, precision poses dynamic measurement and antenna feed dynamic motion precision engineering measurement field. At the construction site of high energy synchrotron radiation source, the laser tracker is often used to calibrate and pre-collimate the high energy source magnet equipment and carry on the tunnel measurement . However, the laser tracker is easily affected by the vibration of the surrounding environment, and the adverse vibration seriously affects its measurement accuracy and even causes the equipment to damage. In order to effectively control the influence of environmental vibration and ensure good static bearing capacity, a broadband vibration isolator for laser tracker is proposed. It is installed in the leg position of the triangular bracket of the laser tracker, which ensures the vibration isolation performance and good bearing capacity. For the above system, the equivalent single freedom nonlinear dynamic differential equation is established, and the steady-state response solution of the broadband isolator is obtained by using the complex variable-average method. The numerical finite element method is used to verify the correctness of the theoretical model and corresponding calculation results. On this basis, the stability of a nonlinear system is analyzed by harmonic balance method, and the influence of key designing parameter <i>K</i><sub>3</sub> on vibration isolation performance is considered. Combined with the complexity of the actual working environment of laser tracker, a variety of typical working conditions are set up for test, including long time static pressure test, vertical impact excitation and lateral displacement excitation tests, to evaluate the static stability and vibration control effect of broadband isolator. The experimental results show that the maximum static displacement of the laser tracker is about 2×10<sup>–5</sup> m under static pressure in a long time, and the maximum static load is within the allowable error range. When the occasional impacting is triggered, the installation of broadband isolator can make the combination quickly restore stability in about 2.95 s, exhibiting better vibration isolation performance. Under different dynamic loads, by comparing the acceleration frequency response curves of the laser tracker with and without the isolator, in the frequency band below the fundamental frequency of the laser tracker, the attenuation rate of the combined system can be up to about 97% with and without the vibration isolator. In the frequency band above the fundamental frequency, the attenuation rate of the combined system with and without the vibration isolation system can reach up to about 88%, and the effective vibration isolation frequency band is extended. The broadband vibration isolator meets all technical requirements.

The Influence of the Inter-Relationship of Leg Position and Riding Posture on Cycling Aerodynamics

Aerodynamics is an important factor affecting cyclist performance, as at the elite level 90% of rider energy is used to overcome aerodynamic drag. As such, much effort has been channeled into understanding the detailed flow around cyclists, since small gains can produce large rewards. Previous studies have shown that cycling aerodynamic drag is sensitive to leg position during the pedaling cycle; however, a systematic analysis comparing the impact of leg position between different riding postures is yet to be undertaken. To address this question, we compare the impact of leg position for two elite-level riding postures: the standard sprint and pursuit body positions. The comparison shows that the effect of leg position on drag is not consistent between the two riding postures, as the altered flow associated with different leg positions is influenced by the wakes from and proximity of other upstream or nearby components, such as the arms. This study reveals the inter-relationship between leg position and riding posture; and suggests that the flow associated with varied leg position should include surrounding geometrical components to obtain and understand the full aerodynamic impact. Practically, the results are valuable for optimizing the posture and improving skin-suit design for drag minimization.

The effect of limb position on a static knee extension task can be explained with a simple spinal cord circuit model.

The influence of proprioceptive feedback on muscle activity during isometric tasks is the subject of conflicting studies. We performed an isometric knee extension task experiment based on two common clinical tests for mobility and flexibility. The task was carried out at four preset angles of the knee, and we recorded from five muscles for two different hip positions. We applied muscle synergy analysis using nonnegative matrix factorization on surface electromyograph recordings to identify patterns in the data that changed with internal knee angle, suggesting a link between proprioception and muscle activity. We hypothesized that such patterns arise from the way proprioceptive and cortical signals are integrated in neural circuits of the spinal cord. Using the MIIND neural simulation platform, we developed a computational model based on current understanding of spinal circuits with an adjustable afferent input. The model produces the same synergy trends as observed in the data, driven by changes in the afferent input. To match the activation patterns from each knee angle and position of the experiment, the model predicts the need for three distinct inputs: two to control a nonlinear bias toward the extensors and against the flexors, and a further input to control additional inhibition of rectus femoris. The results show that proprioception may be involved in modulating muscle synergies encoded in cortical or spinal neural circuits.NEW & NOTEWORTHY The role of sensory feedback in motor control when limbs are held in a fixed position is disputed. We performed a novel experiment involving fixed position tasks based on two common clinical tests. We identified patterns of muscle activity during the tasks that changed with different leg positions and then inferred how sensory feedback might influence the observations. We developed a computational model that required three distinct inputs to reproduce the activity patterns observed experimentally. The model provides a neural explanation for how the activity patterns can be changed by sensory feedback.

Self-repelling bipedal exploration process.

A self-repelling two-leg (biped) spider walk is considered where the local stochastic movements are governed by two independent control parameters β_{d} and β_{h}, so that the former controls the distance (d) between the legs positions, and the latter controls the statistics of self-crossing of the traversed paths. The probability measure for local movements is supposed to be the one for the "true self-avoiding walk" multiplied by a factor exponentially decaying with d. After a transient behavior for short times, a variety of behaviors have been observed for large times depending on the value of β_{d} and β_{h}. Our statistical analysis reveals that the system undergoes a crossover between two (small and large β_{d}) regimes identified in large times (t). In the small β_{d} regime, the random walkers (identified by the position of the legs of the spider) remain on average in a fixed nonzero distance in the large time limit, whereas in the second regime (large β_{d}), the absorbing force between the walkers dominates the other stochastic forces. In the latter regime, d decays in a power-law fashion with the logarithm of time. When the system is mapped to a growth process (represented by a height field which is identified by the number of visits for each point), the roughness and the average height show different behaviors in two regimes, i.e., they show a power law with respect to t in the first regime and logt in the second regime. The fractal dimension of the random walker traces and the winding angle are shown to consistently undergo a similar crossover.

Lower Leg Injury Mechanism Investigation During an IED Blast Under a Vehicle Using an Anatomic Leg Model.

Attacks with improvised explosive device (IED) constituted the main threat to, for example, Polish soldiers in Iraq and Afghanistan. Improving safety during transport in an armored vehicle has become an important issue. The main purpose of the presented research is to investigate the mechanism of lower leg injuries during explosion under an armored vehicle. Using a numerical anatomic model of the lower leg, the analysis of the leg position was carried out. In all presented positions, the stress limit of 160 (MPa) was reached, which indicates bone damage. There is a difference in stress distribution in anatomic elements pointing to different injury mechanisms.

Comparison of Mechanical Performance between Circular Frames and Biplanar Distraction Devices for Knee Joint Distraction.

Aim and objectiveThis study was designed to test and compare the mechanical performance of the biplanar ArthroSave KneeReviver and a circular frame construct with the intended use of providing a mechanically favourable environment for cartilage regeneration across a knee joint.Materials and methodsThree similar constructs of the two devices were applied to biomechanical testing sawbones, with the knee distracted by 8 mm. The constructs were vertically loaded to 800 N in an Instron testing machine at 20 mm/minute. Tests were conducted in neutral hip flexion and at 12° of hip flexion and extension, to mimic leg position in gait. Displacement measurements were taken from the Instron machine, and three-dimensional joint motion was recorded using an Optotrak Certus motion capture system.ResultsOverall axial rigidity was similar between the two devices (circular frame, 81.6 N/mm ± 5.9; and KneeReviver, 79.5 N/mm ± 25.1 with hip neutral) and similar in different hip positions. At the point of joint contact, the overall rigidity of the circular frame increased significantly more than the KneeReviver (491 N/mm ± 27 and 93 N/mm ± 32, respectively, p <0.001). There was more variability between models in the KneeReviver. There was more off-axis motion in the KneeReviver, mainly due to increasing knee flexion on loading. This was exacerbated with the hip in flexion and extension but remained small, with the maximal off-axis displacement being 7 mm/3°.ConclusionThe circular frame provides a similar mechanical environment to the novel KneeReviver device, for which most clinical data are available. These findings suggest that both devices appear a viable option for knee joint distraction (KJD). Further clinical data will help inform mode of application.Clinical significanceKJD is a relatively novel technique for use in osteoarthritis (OA), and it remains unclear which distraction devices provide appropriate mechanics. Our testing gives evidence to support either option for further use.How to cite this articleChowdhury JMY, Lineham B, Pallett M, et al. Comparison of Mechanical Performance between Circular Frames and Biplanar Distraction Devices for Knee Joint Distraction. Strategies Trauma Limb Reconstr 2021;16(2):71–77.

1001 Atraumatic Bilateral Compartment Syndrome; A Case Report

Abstract Introduction We present a rare case of lower leg atraumatic bilateral compartment syndrome (ABCS). To date there have only been three similar cases reported where no cause was identified. Case Study A 33-year-old male presented 12 hours following sudden onset lower leg pain. There was no history of trauma, drug, or alcohol use. On assessment he was in significant pain, not relieved by analgesia, and had clinically tense anterior compartments bilaterally. Both feet were held in fixed dorsiflexion. Creatinine kinase (CK) was 35,166 on admission. X-rays of both legs were normal. He was immediately taken to theatre for bilateral four compartment fasciotomies which revealed significant swelling in the anterior and lateral compartments with patchy pre-necrosis. Post-operatively he deteriorated, required intubation, and was admitted to ITU for acute haemofiltration to treat acute kidney injury secondary to rhabdomyolysis. Multiple operations were required for debridement, resulting in exposed tendons. Closure of the medial wounds was achieved primarily as an inpatient and he was discharged with bilateral lateral VAC dressings in situ. Lateral wounds were closed with Biodegradable Temporising Matrix followed by split skin grafting. In his second admission he suffered a pulmonary embolism. Literature Review and Discussion 20 case of ABCS have been reported, largely attributable to drugs, alcohol, or leg position. Most cases had an element of diagnostic delay. In addition to compartment pressure monitoring, testing CK can demonstrate muscle necrosis and supports the decision to proceed to surgery.

MATLAB-based tools for automated processing of motion tracking data provided by the GRAIL.

The ability for independent bipedal locomotion is an important prerequisite for autonomous mobility and participation in everyday life. Walking requires not only a functional musculoskeletal unit but relies on coordinated activation of muscles and may even require cognitive resources. The time-resolved monitoring of the position of joints, feet, legs and other body segments relative to each other alone or in combination with simultaneous recording of ground reaction forces and concurrent measurement of electrical muscle activity, using surface electromyography, are well-established tools for the objective assessment of gait. The Gait Real-time Analysis Interactive Lab (GRAIL) has been introduced for gait analysis in a highly standardized and well-controlled virtual environment. However, apart from high computing capacity and sophisticated software required to run the system, handling of GRAIL data is challenging due to the utilization of different software packages resulting in a huge amount of data stored using different file formats and different sampling rates. These issues make gait analysis even with such a sophisticated instrument rather tedious, especially within the frame of an experimental or clinical study. A user-friendly Matlab based toolset for automated processing of motion capturing data recorded using the GRAIL, with the inherent option for batch analysis was developed. The toolset allows the reading, resampling, filtering and synchronization of data stored in different input files recorded with the GRAIL. It includes a coordinate-based algorithm for the detection of initial contact and toe-off events to split and normalize data relative to gait cycles. Batch processing of multiple measurements and automatic detection of outliers is possible. The authors hope that the toolset will be useful to the research community and invite everyone to use, modify or implement it in their own work.

The predictive value of microperfusion assessments for the follow-up of tibial bypass grafts

ObjectiveWe conducted a prospective evaluation of microperfusion parameters after tibial bypass surgery was performed. Differences between grafts with occlusions during follow-up and patent grafts were analyzed in relation to the pedal arch quality. MethodsPatients receiving tibial bypass grafts for chronic limb-threatening ischemia from 2019 to 2020 were included. Assessment of microcirculation (parameters: hemoglobin oxygen saturation [sO2] and flow) was done by laser Doppler flowmetry and white light spectrometry (oxygen-to-see), supine and in elevation, whereas the macrocirculation was evaluated by the ankle-brachial index and duplex ultrasound examination. The quality of run-off was graded for each patient. Measurements were performed preoperatively, 1 day postoperatively, and after 6 months. Patients with graft occlusions during follow-up (OCCLUDED) and patients without occlusions (OPEN) were compared. ResultsWe included 42 patients (13 women, 29 men; mean age, 76.1 years; range, 60-89 years) were included. The patency of all grafts 1 day after the operation was confirmed by ultrasound examination. The overall analysis of the microcirculation showed significant changes in both the supine and elevated leg position between measurements taken preoperatively, 1 day after the operation, and after 6 months for the parameters sO2 and FLOW (sO2 supine, P = .001; sO2 elevated, P < .001; FLOW supine, P < .001; FLOW elevated, P < .001). The comparison of the values 1 day after the operation yielded significantly decreased microperfusion parameters (both O2 and FLOW) in the group that developed bypass occlusion in the later follow-up period (sO2 supine: OCCLUDED, 35.7% [7.3-65.0] and OPEN, 48.7% [25.0-72.3] P = .011; FLOW supine: OCCLUDED, 27.7 A.U. [12.7-52.7] and OPEN, 57.3 A.U. [16.0-106.7], P = .008). No significant differences in the severity of the arch impairment was found between the OPEN and OCCLUDED groups (P = .651). Absolute values of the parameters sO2 and flow showed no correlation with the pedal arch classification. ConclusionsSignificantly poorer microperfusion was detected postoperatively in patients with later occurrence of graft occlusions despite patent grafts on the first postoperative day. Microperfusion measurements might be a possible tool for the prediction of graft failure.

An In Vivo Data-Based Computational Study on Sitting-Induced Hemodynamic Changes in the External Iliac Artery.

Although sedentary behavior (characterized by prolonged sitting without otherwise being active in daily life) is widely regarded as a risk factor for peripheral artery disease (PAD), underlying biomechanical mechanisms remain insufficiently understood. In this study, geometrical models of ten external iliac arteries were reconstructed based on angiographic data acquired from five healthy young subjects resting in supine and sitting (mimicked by side lying with bent legs) positions, respectively, which were further combined with measured blood flow velocity waveforms in the common iliac arteries (with each body posture being maintained for 30 min) to build computational models for simulating intra-arterial hemodynamics. Morphological analyses showed that the external iliac arteries suffered from evident bending deformation upon the switch of body posture from supine to sitting. Measured blood flow velocity waveforms in the sitting position exhibited a marked decrease in mean flow velocity while increase in retrograde flow ratio compared with those in the supine position. Hemodynamic computations further revealed that sitting significantly altered blood flow patterns in the external iliac arteries, leading to a marked enlargement of atheroprone wall regions exposed to low and oscillatory wall shear stress (WSS), and enhanced multidirectional disturbance of WSS that may further impair endothelial function. In summary, our study demonstrates that prolonged sitting induces atheropromoting hemodynamic changes in the external iliac artery due to the combined effects of vascular bending deformation and changes in flow velocity waveform, which may provide important insights for understanding the involvement of biomechanical factors in sedentary behavior-related PAD.

MP58-19 ROLE OF 3D MOTION TRACKING TECHNOLOGY IN POST-OPERATIVE RECOVERY AFTER MAJOR UROLOGIC SURGERY: A PILOT STUDY

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety IV (MP58)1 Sep 2021MP58-19 ROLE OF 3D MOTION TRACKING TECHNOLOGY IN POST-OPERATIVE RECOVERY AFTER MAJOR UROLOGIC SURGERY: A PILOT STUDY Umar Iqbal, Somayeh B. Shafiei, Zhe Jing, Philippa Doherty, Mohammad Durrani, Ahmed S. Elsayed, Ahmed A. Hussein, and Khurshid A. Guru Umar IqbalUmar Iqbal More articles by this author , Somayeh B. ShafieiSomayeh B. Shafiei More articles by this author , Zhe JingZhe Jing More articles by this author , Philippa DohertyPhilippa Doherty More articles by this author , Mohammad DurraniMohammad Durrani More articles by this author , Ahmed S. ElsayedAhmed S. Elsayed More articles by this author , Ahmed A. HusseinAhmed A. Hussein More articles by this author , and Khurshid A. GuruKhurshid A. Guru More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002088.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Early ambulation post-operatively is key to promote recovery and decrease complications after major surgery. However, there is lack of objective evaluation of ambulation in terms of quantity (time) and quality (type of movement). We sought to utilize commercially available 3D-motion tracking technology to measure the kinematic features of postoperative ambulation explore its association with recovery. METHODS: 16 consecutive patients who underwent robot-assisted radical cystectomy were included (I-80918). Xsens® 3D motion capture technology was used to measure kinematic features of the participants during their post-operative inpatient stay period. Data was recorded for duration, position, velocity, angular velocity, acceleration, and angular acceleration of pelvis, upper leg (left & right), lower leg (left & right) and foot (left & right) (Table 1). Motion segments of recorded XSENS® data were extracted and decontaminated using signal processing algorithms proposed in XSENS MVN® Software. The association of kinematic features with time to flatus, time to bowel motion, pain scores and length of inpatient stay was examined using a multivariate mixed model. RESULTS: Median age was 67 years (IQR 60-73) and patients were followed for 4.25 ± 1.53 days postoperatively. All participants had similar kinematic features between left-side and right-side on their feet, lower legs and upper legs. The ‘average velocity of pelvis’ was negatively associated with inpatient stay: every 0.1 m/sec increase of daily average pelvis velocity was associated with 0.32 days shorter hospital stay (Figure 1). Higher daily ‘average velocity of pelvis’ was positively correlated with having flatus: every 0.1 m/s increase of daily average pelvis linear velocity was associated with 2.05 times more likelihood of passing flatus. CONCLUSIONS: Kinematic metrics, as a surrogate for postoperative ambulation, are associated with length of inpatient stay and time to flatus post cystectomy. Source of Funding: Roswell Park Alliance Foundation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e995-e996 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Umar Iqbal More articles by this author Somayeh B. Shafiei More articles by this author Zhe Jing More articles by this author Philippa Doherty More articles by this author Mohammad Durrani More articles by this author Ahmed S. Elsayed More articles by this author Ahmed A. Hussein More articles by this author Khurshid A. Guru More articles by this author Expand All Advertisement Loading ...

A multiparametric approach to assessing residual pain experienced by dairy cows undergoing digestive tract surgery under multimodal analgesia

This study assessed residual pain responses of dairy cows undergoing fistulation surgery under multimodal analgesia using a multiparametric method combining behavioural and physiological indicators. A longitudinal study was conducted on five dairy cows, each acting as her own control. The surgery consisted of implanting a ruminal and a duodenal cannula in each cow. The multimodal drug protocol consisted of a combination of N-Methyl-D aspartic Acid antagonists, α2-agonists, and local anaesthetic during surgery, and non-steroidal anti-inflammatory drugs (NSAIDs) and opioid treatment postsurgery. Cow responses to surgery were monitored by direct behavioural observation, physiological assay indicators, and milk production from day (D) −6 days before surgery (D-6) to D13 postsurgery. From the data recorded, the variables that contributed most to the discrimination of days pre- and postsurgery were identified using factorial discriminant analysis. Components 1 and 2 of the factorial discriminant analysis explained 68.2% and 17.9%, respectively, of the total variance. Component 1 was mainly explained by haptoglobin (contribution to axis: 0.885), oxidative stress (ratio of oxidized gluthatione to reduced glutathione (GSH/GSSG), −0.746; vitamin E, −0.683; vitamin A, −0.597; malondialdehyde (MDA), 0.416), and behavioural indicators (general attitude, 0.594). On this axis, the higher the score, the higher were the apathy and haptoglobin and MDA concentrations, and the lower were the GSH/GSSG ratio and concentrations of vitamins A and E. This axis opposed cows on D-6 to cows on D3 and D5; cows on D1 and D13 were intermediate. Component 2 was mainly explained by the Hypothalamic-pituitary-adrenal axis (non-esterified fatty acid (NEFA), 0.686; cortisol, 0.669), milk yield (−0.725), oxidative stress (MDA, −0.584; nitric oxide (NO), 0.454), and behavioural indicators of pain (ear position, 0.467; leg postures, 0.431). On this axis, the higher the score, the higher the NEFA, cortisol, and nitric oxide concentrations; the more the ear and leg pain postures; and the lower the milk production and MDA concentrations. This axis opposed cows on D13 to cows on D1. These results suggest that cows may experience some pain only on D1, whereas on subsequent days, the inflammatory response and oxidative stress did not seem to be associated with pain. Our results should be considered for different surgeries to improve analgesia immediately after surgery, and to provide antioxidants along with NSAIDs to promote recovery.

Probabilistic Uncertainty Quantification of Borehole Thermal Resistance in Real-World Scenarios

The thermal resistance of a borehole heat exchanger (BHE) varies significantly depending on the position of the pipe legs. However, the pipe position cannot be fully controlled during its construction because of extreme slenderness of BHEs. As a result, the borehole thermal resistance (Rb) estimated from one BHE cannot represent the entire borefield. This study probabilistically quantified the uncertainty of Rb caused by the inherent uncertain characteristics through Monte Carlo simulations. The following four scenarios were considered: 1) pipe legs move along the central axis of the borehole, 2) insertion of a U-tube using spacers to maintain the shank spacing, 3) pipe legs freely located inside the borehole, and 4) considering uncertainty of the pipe location, borehole radius, and thermal conductivities of the grout and ground. The results demonstrated that the use of spacers significantly improves Rb and reduces its uncertainty range. The results of the last scenario revealed that the maximum Rb could be more than twice the minimum value. Moreover, the spatial variation of Rb according to the pipe position was systematically analyzed to clarify the dynamics of b change. The results suggest that Rb obtained through a thermal response test cannot adequately represent the entire borefield.

Rehabilitation of Acute and Chronic Ankle Sprain for Male Cricketers Through Headway (Isometric, Isotonic and Proprioception) Exercises

The present study investigated that Headway (Isometric, Isotonic and Proprioception) exercises are effective for acute &amp; chronic ankle sprain injury, which was observed through experimental research. Ninety-four amateur cricketers of age, 15-35 years (Control Injured, N=48; Headway Rehab Group N=46) with a confirmed acute or chronic ankle sprain, selected from four different cities of Punjab, Pakistan was evaluated through Star Excursion Balance Test (SEBT), Single Leg Balance test (SLB) and subject to a set of progressively increasing exercises on ground known as Headway rehab exercises which consisted of Isometric, Isotonic and proprioception protocols. Another group of the same level of cricketers (N=40) was managed parallel for comparisons. The Control Injured and Headway Rehab Group was left with 40 subjects each because during the course of Headway exercise eight and six subjects left the study due to their personal reasons. Comparisons of pre and post-exercise (Control Injured Group) values showed a significant increase (p&lt;0.001) in Lateral direction reach and Posteromedial direction (p&lt;0.05) while the rest of the six directions showed non-significant results. Headway Rehab Group showed an overall improvement of 5.2% and 7.5% with an increase (cm) of 3.4 and 4.9 for the non-injured and injured leg respectively. However, the range of improvement in percentage for all eight directions (anterior, anterolateral, lateral, posterolateral, posterior, posteromedial, medial, anteromedial) lies between 5.7-7.1(range) and 6.3-9.6 (range) for the non-injured and injured leg respectively. Similarly, the difference between pre and post-exercise difference of two positions of non-injured leg and injured leg (closed and open eyes) in seconds were 2.9, 12.1 and 4.1, 27.7 respectively. However, the improvement percentage of two directions (closed and open eyes) of Headway Rehab Group was 44.9 and 75.3 for non-injured and 12.7 and 51.6 per cent for injured group respectively. It was evaluated through the Single Leg Balance Test and analyzed by paired sample t-test found highly significant (p&lt;0.001). The results indicated that Headway exercises improved isometric and isotonic muscular strength, proprioception and stability that ultimately helped to recover, regaining strength and reinstall proprioception. After completing the Headway Rehab plan the subjects were followed for four months to check the recurrence and found recurrence of Control Injured Group and Headway Rehab Group was 17.5% and 12.5% respectively.

Figure-of-nine position: A convenience trick for standard technique of ACL reconstruction

While position of leg during arthroscopy may not affect clinical outcome of a well-done ACL reconstruction, better view during reconstruction, more efficient fluid ingress in position of hyperflexion during femoral tunnel drilling, decreased crowding of instrumentation, and convenient disposition during surgery for surgeon and assistant with need for reduced logistics are some advantages of figure of nine position. Adoption of this alternative position in arthroscopic ACL reconstruction is easy because it does not require alteration to standard technique of ACL reconstruction. There are even greater merits for considering this position for three portal medial viewing medial drilling techniques.

Neuromuscular taping treatment of diabetic foot: a concept analysis.

The definition of neuromuscular taping (NMT) has yet to be clearly analysed as a possible treatment for diabetic foot. Case studies, theoretical analysis and results of existing research may lead to varying perceptions on the definition of NMT and its possible effects on diabetic foot. This article aims to analyse the definition of the NMT concept and furthermore as a basis for future research development on diabetic foot. The procedure for reference source search include the principal data bases using "neuromuscular taping" and "diabetic foot" keywords for the period of 2010-2019. The concept analysis uses an 8-step approach with the Walker and Avant's method. NMT is a decompression application of an elastic tape on the skin on the diabetic foot that has the effect of reducing the inflammatory response, improving vascularity and neuromusculoskel-etal function. It aims to improve neuromusculoskeletal and lymphatic system functioning due to the presence of wrinkles, indicating dila-tion, with local effects on the sensorimotor and proprioceptive senses in conditions of care, rehabilitation and injury. Analysis of the NMT concept on diabetic foot obtained attributes of elastic tape, skin, pain, edema, injury, sensorimotor, circulation, drainage, relaxation, local, proprioceptive, motion func-tion, strength, contraction, stabilisation, reflex, rehabilitation, care, musculoskeletal, nerve, muscles, tendons, fascia, joints, lymphatic, longitudinal, wrinkles. There were four groups of attributes, namely inflammatory response, vascularity, neuromusculoskeletal function and musculoskeletal system. NMT application benefits for diabetic foot can be attributed to improving walking function, leg position, decreasing pain response, improving body function index, improving leg muscle strength and motor function, increasing range of movement (ROM), maintaining stability of leg joint function, preventing injury, increas-ing strength and improving position of ankle joints, reducing stiffness, reducing edema and helping wound healing processes.