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Using magnetic resonance imaging (MRI) in conjunction with synchronized spirometry we analyzed and compared diaphragm movement during tidal breathing and voluntary movement of the diaphragm while breath holding. Breathing cycles of 16 healthy subjects were examined using a dynamic sequence (77 slices in sagittal plane during 20 s, 1NSA, 240x256, TR4.48, TE2.24, FA90, TSE1, FOV 328). The amplitude of movement of the apex and dorsal costophrenic angle of the diaphragm were measured for two test conditions: tidal breathing and voluntary breath holding. The maximal inferior and superior positions of the diaphragm were subtracted from the corresponding positions during voluntary movements while breath holding. The average amplitude of inferio-superior movement of the diaphragm apex during tidal breathing was 27.3±10.2 mm (mean ± SD), and during voluntary movement while breath holding was 32.5±16.2 mm. Movement of the costophrenic angle was 39±17.6 mm during tidal breathing and 45.5±21.2 mm during voluntary movement while breath holding. The inferior position of the diaphragm was lower in 11 of 16 subjects (68.75 %) and identical in 2 of 16 (12.5 %) subjects during voluntary movement compared to the breath holding. Pearson’s correlation coefficient was used to demonstrate that movement of the costophrenic angle and apex of the diaphragm had a linear relationship in both examined situations (r=0.876). A correlation was found between the amplitude of diaphragm movement during tidal breathing and lung volume (r=0.876). The amplitude of movement of the diaphragm with or without breathing showed no correlation to each other (r=0.074). The movement during tidal breathing shows a correlation with the changes in lung volumes. Dynamic MRI demonstrated that individuals are capable of moving their diaphragm voluntarily, but the amplitude of movement differs from person to person. In this study, the movements of the diaphragm apex and the costophrenic angle were synchronous during voluntary movement of the diaphragm while breath holding. Although the sample is small, this study confirms that the function of the diaphragm is not only respiratory but also postural and can be voluntarily controlled.

Total hip arthroplasty is a cost-effective surgical procedure undertaken to relieve pain and restore function to the arthritic hip joint. More than 1 million arthroplasties are done every year worldwide, and this number is projected to double within the next two decades. Symptomatic osteoarthritis is the indication for surgery in more than 90% of patients, and its incidence is increasing because of an ageing population and the obesity epidemic. Excellent functional outcomes are reported; however, careful patient selection is needed to achieve best possible results. The present economic situation in many developed countries will place increased pressure on containment of costs. Future demand for hip arthroplasty, especially in patients younger than 65 years, emphasises the need for objective outcome measures and joint registries that can track lifetime implant survivorship. New generations of bearing surfaces such as metal-on-metal, ceramic-on-ceramic, and metal-on-ceramic, and techniques such as resurfacing arthroplasty have the potential to improve outcomes and survivorship, but findings from prospective trials are needed to show efficacy. With the recall of some metal-on-metal bearings, new bearing surfaces have to be monitored carefully before they can be assumed to be better than traditional bearings.

The learning process can be seen as an emotional and personal experience that is addictive and motivates learners to proactive behaviour. New research methods in this field are related to affective and emotional approaches to computer-supported learning and human-computer interactions. The major topics discussed are emotions, motivation, games and game-experience. The book is divided in three parts, part I, Game-based Learning, reflects upon the two-way interaction between game and student, thus enabling the game to react to the student's emotional state. Having the possibility to detect and steer the emotional state of the student could have a positive impact on using digital games in education. It is claimed that some commercial computer games increase cognitive skills and may enhance multitasking abilities and the participants' general ability to learn. Part II, Motivation and Learning, analyses whether the absence or presence of social and personal cues in the communication between a tutor and his or her students influence students' learning and their satisfaction with the tutor and the course. The research showed that not all types of personal information are equally important and possibly pictorial information is more important than audible information. Part III, Emotions and Emotional Agents, discusses the production of learning environments which enhance the learner's self esteem, ensure that the learner's best interests are respected through paying attention to the narrative structures of the learner's experience, and the ways in which communication can be enhanced through empathy with the learner.

PurposeAseptic loosening is a common cause of implant failure following total knee arthroplasty (TKA). Cement penetration depth is a known factor that determines an implant’s “strength” and plays an important role in preventing aseptic loosening. Tourniquet use is thought to facilitate cement penetration, but its use has mixed reviews. The aim of this study was to compare cement penetration depth between tourniquet and tourniquet-less TKA patients.MethodsA multicenter retrospective review was conducted. Patients were randomized preoperatively to undergo TKA with or without the use of an intraoperative tourniquet. The variables collected were cement penetration measurements in millimeters (mm) within a 1-month post-operative period, length of stay (LOS), and baseline demographics. Measurements were taken by two independent raters and made in accordance to the zones described by the Knee Society Radiographic Evaluation System and methodology used in previous studies.ResultsA total of 357 TKA patients were studied. No demographic differences were found between tourniquet (n = 189) and tourniquet-less (n = 168) cohorts. However, the tourniquet cohort had statistically, but not clinically, greater average cement penetration depth [2.4 ± 0.6 mm (range 1.2–4.1 mm) vs. 2.2 ± 0.5 mm (range 1.0–4.3 mm, p = 0.01)]. Moreover, the tourniquet cohort had a significantly greater proportion of patients with an average penetration depth within the accepted zone of 2 mm or greater (78.9% vs. 67.3%, p = 0.02).ConclusionTourniquet use does not affect average penetration depth but increases the likelihood of achieving optimal cement penetration depth. Further study is warranted to determine whether this increased likelihood of optimal cement penetration depth yields lower revision rates.

This systematic review evaluated the combined effects of obesity and surgical approach on periprosthetic joint infection (PJI) rates after total hip arthroplasty (THA). Wound complication and PJI rates were elevated among patients with body mass index (BMI) of 30 kg/m2 or greater and 35 kg/m2 or greater, respectively, with the direct anterior approach (DAA). A BMI of 30 kg/m2 or greater also increased the risk of PJI with the posterior approach. Patients with BMI of 30 kg/m2 or greater undergoing anterolateral approach THA did not have increased risk of PJI. Patients with elevated BMI (≥30 kg/m2) are at risk for PJI, regardless of approach. Patients undergoing DAA THA who have BMI of 35 kg/m2 or greater may have an increased risk of PJI compared with those undergoing THA with other approaches. [Orthopedics. 2022;45(2):e67–e72.]

Purpose The purpose of this study was to compare the clinical outcomes of patients undergoing total hip arthroplasty (THA) who had been using narcotic medications prior to surgery to those who had not used them. Methods Fifty-four patients (62 hips) who had required opioid analgesia for hip pain in the three months prior to THA were compared to a matched group of opioid-naïve patients. Narcotic consumption was converted to a standardized morphine equivalent dose and compared between both groups of patients during their hospital stay, after six weeks, and at final follow-up. Other outcome measures included clinical outcome scores and the proportion of patients remaining on narcotic pain medication at final follow-up. Results The narcotic group required significantly higher total daily opioid doses as inpatients had a longer hospital stay and a higher proportion of patients who remained on opioids at six weeks and at final follow-up. Of the patients who were taking opioids pre-operatively, 81 % were able to wean off opioids at final follow-up. At a mean post-operative follow-up of 58 months (range, 24–258 months), Harris hip scores were lower in the narcotic group, with a mean of 84 compared to 91 points in the matching group. However, in both cohorts, there were significant improvements in Harris hip scores compared to pre-operative outcomes. Conclusions Patients who use narcotics prior to total hip arthroplasty may be more likely to suffer from opioid-induced hyperalgesia after surgery and have worse clinical outcomes. When possible, efforts should be made to use other modes of analgesia or wean patients from their use prior to total hip arthroplasty.

Line width is one of the major factors affecting arable soil erosion. The aim of the study was to assess the effects of different row spacing on splash erosion and throughfall in maize crops. Field measurements of the throughfall (Pth, mm) and splash erosion (MSR, g/m2) were carried out in silage maize crops (row spacing 0.45 and 0.75 m) in 2012-2014. The BBCH growth stages for the crops, plant length (L, m), and leaf area index (LAI) were evaluated. Positive correlation was observed between the aerial precipitation (P, mm) and the Pth values. With increasing P-values, higher levels of Pth were identified in the 0.75 m compared to the 0.45 m row spacing. The value of this proportion was decreasing from the centre of the inter-row (0.75 m) to the row of the plants direction. Statistically significant lower values of splash erosion were observed in the 0.45 m compared with the 0.75 m wide rows, especially within the years 2012 and 2014. The experiments proved the positive influence of the length of plants and LAI on P/Pthvalues. A decrease of Pth in relation to precipitation values with height of plants and LAI values was observed. This dependency was then confirmed from the beginning of the stem elongation (BBCH 30) to the end of flowering (BBCH 70). Tighter dependency between the plant length (L) and the values of P/Pth ratio in the 0.75 m wide crop rows was determined. Conversely, a more important influence of LAI on the values of P/Pth ratio was estimated in the 0.45 m wide crop rows. The experiments proved the positive influence of the 0.45 m wide rows on the decrease of splash erosion as well as throughfall compared with the 0.75 m row spacing.

Soil under maize cropping is among the most endangered by erosion. The effect of conservation tillage management on values of splash erosion when using shallow strip tillage before sowing maize was evaluated in the Central Bohemian region (Czech Republic) during the period 2010–2012. The following types of tillage management using conventional technology and shallow tillage were evaluated: ploughed plots with mulch formed by weed biomass (PLW), ploughed plots with mulch from perennial ryegrass plants (PLPR), ploughed plots without mulch (PL) and shallow tillage (ST) where the mulch was formed by cereals straw. Furthermore, values of the splash erosion, plants and plant residues coverage ratio of soil by image analysis and the stability of soil aggregates were monitored during the whole experiment. The average value of splash erosion (MSR) was higher by 18.7% in the variant of PLW, lower by 35.9% in PLPR, and lower by 39.5% in ST, than in the control treatment PL (MSR value for PL = 100%) for the whole evaluated period (2010–2012). The average values of the soil surface plant coverage ratio in the plots with mulch ranged from 1.5 to 43.0% at the beginning of the vegetation period, and from 4.9 to 85.5% in the second half of the vegetation period. A positive correlation was observed between the average values of the stability of soil aggregates and the plant coverage ratio of the soil surface in 2010 and 2011.

The objective of this study was to evaluate the levels of cis- and trans-isomers of resveratrol and piceid contained in the shoots, leaves and tendrils of six grapevine varieties and three locations processed under two different drying conditions. The highest trans-resveratrol content was found in the shoots; trans-piceid was contained in lesser amounts (7%) and cis-forms only in very small amounts (~1%). In leaves, both forms of piceid were dominant, while in tendrils trans- and cis-forms of piceid were dominant in samples dried in the laboratory oven at 40°C. Pinot Noir differed from other varieties with a high trans-resveratrol amount. Growing location affected trans-resveratrol levels. Our results suggest that the trimmed clippings might be used as a valuable and inexpensive source of stilbenes. Clippings preserved by drying might be further processed to nutraceuticals or as an additive to the feed.

This article reports a rare case of late-onset tubercular infection following total knee arthroplasty in a 60-year-old woman who had been treated with a full course of antitubercular therapy for latent tuberculosis almost 25 years ago. Because no clear guidelines exist for optimal management of disease reactivation in the prosthetic knee joint, the authors performed a literature review and attempted to provide a treatment algorithm based on the time of presentation. Two modes of presentation were identified for unsuspected tubercular prosthetic joint infections based on the onset of symptoms and time to diagnosis: an early-onset presentation that occurs within the first 6 to 8 weeks postoperatively and a late-onset presentation that usually manifests after 8 weeks. Early-onset presentations often can be treated with standard antitubercular chemotherapy alone, whereas late-onset presentation may require 2-stage reimplantation under cover of antitubercular medications. This report also highlights the fact that despite adequate treatment of latent tuberculosis, patients may remain at risk of prosthetic joint infection following total knee arthroplasty.