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Purpose The aim of the present study was to examine changes in radiological variables in a prospective randomized study comparing opening wedge (OW) and closing wedge (CW) techniques of high tibial osteotomy (HTO). Our hypothesis was that there would be no differences in joint line angles or correction accuracy between the two groups, that patellar height would increase after CW HTO and decrease after OW HTO, and that leg length and posterior tibial slope would decrease after CW HTO and increase after OW HTO. Methods Radiological data were collected from 70 patients participating in an ongoing prospective randomized clinical trial comparing OW and CW HTOs. Digital standing hip–knee–ankle (HKA) radiographs as well as lateral radiographs in 30° of flexion were obtained preoperatively and at 6 months for each patient. Joint line angles, HKA angle, leg length, Insall–Salvati index, Miura–Kawamura index and posterior tibial slope were measured using medical planning software. The complete preoperative radiological examinations of the first 50 patients were used in a study of intra- and inter-rater reliability of the measurements. Results The mean posterior slope was reduced by 2.5° in CW HTO, whereas it remained unchanged in OW HTO ( p  < 0.001). Mean leg length decreased 5.7 mm in CW HTO and increased 3.1 mm in OW HTO ( p  < 0.001). Changes in joint line angles, patellar height indexes and the correction accuracy showed no significant differences comparing the two techniques. Frontal plane reliability measurement intra- and inter-rater intraclass correlation coefficient (ICC) varied from 0.81 to 0.99. Sagittal plane intra- and inter-rater ICC varied from 0.60 to 0.87. Posterior tibial slope intra- and inter-rater ICC showed the lowest values (0.70 and 0.60, respectively) corresponding to a smallest real difference of 4.5° and 5.5°, respectively. Conclusions Posterior tibial slope and leg length changes were significantly different in CW compared to OW HTOs. We recommend that possible alterations in tibial slope and leg length are considered when the technique of HTO is to be chosen. Landmark-based medical planning software shows good reliability and can be used in preoperative planning and postoperative evaluations of HTOs. Level of evidence I.

Normal displacement of the conus medullaris with unilateral and bilateral SLR has been quantified and the \"principle of linear dependence\" has been described. Explore whether previously recorded movements of conus medullaris with SLRs are i) primarily due to transmission of tensile forces transmitted through the neural tissues during SLR or ii) the result of reciprocal movements between vertebrae and nerves. Controlled radiologic study. Ten asymptomatic volunteers were scanned with a 1.5T magnetic resonance (MR) scanner using T2 weighted spc 3D scanning sequences and a device that permits greater ranges of SLR. Displacement of the conus medullaris during the unilateral and sham SLR was quantified reliably with a randomized procedure. Conus displacement in response to unilateral and sham SLRs was quantified and the results compared. The conus displaced caudally in the spinal canal by 3.54±0.87 mm (mean±SD) with unilateral (p≤.001) and proximally by 0.32±1.6 mm with sham SLR (p≤.542). Pearson correlations were higher than 0.99 for both intra- and inter-observer reliability and the observed power was 1 for unilateral SLRs and 0.054 and 0.149 for left and right sham SLR respectively. Four relevant points emerge from the presented data: i) reciprocal movements between the spinal cord and the surrounding vertebrae are likely to occur during SLR in asymptomatic subjects, ii) conus medullaris displacement in the vertebral canal with SLR is primarily due to transmission of tensile forces through the neural tissues, iii) when tensile forces are transmitted through the neural system as in the clinical SLR, the magnitude of conus medullaris displacement prevails over the amount of bone adjustment.

BackgroundVenous access in patients with obesity presents significant challenges. The success of central venous catheterisation largely depends on the cross-sectional area (CSA) of the internal jugular vein (IJV). While techniques like the Trendelenburg position have been traditionally used to increase IJV CSA, recent studies suggest its ineffectiveness in patients with obesity. Conversely, the potential of the effect of passive leg raising (PLR) has not been thoroughly investigated in this group of patients.MethodsThis protocol outlines a planned randomised controlled trial to evaluate the effect of PLR on the CSA of the IJV in patients with obesity slated for central venous catheterisation. The protocol involves dividing 40 participants into two groups: one undergoing PLR and another serving as a control group without positional change. The protocol specifies measuring the CSA of the IJV via ultrasound as the primary outcome. Secondary outcomes will include the success rates of right IJV cannulation. The proposed statistical approach includes the use of t-tests to compare the changes in CSA between the two groups, with a significance threshold set at p<0.05.Ethics approvalThis study has been approved by the Institutional Review Board of Shanghai Tongren Hospital. All the participants will provide informed consent prior to enrolment in the study. Regarding the dissemination of research findings, we plan to share the results through academic conferences and peer-reviewed publications. Additionally, we will communicate our findings to the public and professional communities, including patient advocacy groups.Trial registration numberChiCTR: ChiCTR2400080513.

Skeletal muscle protein metabolism is resistant to the anabolic action of insulin in healthy, nondiabetic older adults. This defect is associated with impaired insulin-induced vasodilation and mTORC1 signaling. We hypothesized that, in older subjects, pharmacological restoration of insulin-induced capillary recruitment would improve the response of muscle protein synthesis and anabolism to insulin. Twelve healthy, nondiabetic older subjects (71 ± 2 years) were randomized to two groups. Subjects were studied at baseline and during local infusion in one leg of insulin alone (Control) or insulin plus sodium nitroprusside (SNP) at variable rate to double leg blood flow. We measured leg blood flow by dye dilution; muscle microvascular perfusion with contrast enhanced ultrasound; Akt/mTORC1 signaling by Western blotting; and muscle protein synthesis, amino acid, and glucose kinetics using stable isotope methodologies. There were no baseline differences between groups. Blood flow, muscle perfusion, phenylalanine delivery to the leg, and intracellular availability of phenylalanine increased significantly (P < 0.05) in SNP only. Akt phosphorylation increased in both groups but increased more in SNP (P < 0.05). Muscle protein synthesis and net balance (nmol · min(-1) · 100 ml · leg(-1)) increased significantly (P < 0.05) in SNP (synthesis, 43 ± 6 to 129 ± 25; net balance, -16 ± 3 to 26 ± 12) but not in Control (synthesis, 41 ± 10 to 53 ± 8; net balance, -17 ± 3 to -2 ± 3). Pharmacological enhancement of muscle perfusion and amino acid availability during hyperinsulinemia improves the muscle protein anabolic effect of insulin in older adults.

Peripheral artery disease (PAD) is important to public health as a major contributor to cardiovascular morbidity and mortality. Recent developments in magnetic resonance imaging (MRI) techniques permit improved assessment of PAD anatomy and physiology, and may serve as surrogate end points after proangiogenic therapies. The PACE study is a randomized, double-blind, placebo-controlled clinical trial designed to assess the physiologic impact and potential clinical efficacy of autologous bone marrow–derived ALDHbr stem cells. The primary MRI end points of the study are as follows: (1) total collateral count, (2) calf muscle plasma volume (a measure of capillary perfusion) by dynamic contrast-enhanced MRI, and (3) peak hyperemic popliteal flow by phase-contrast MRI (PC-MRI). The interreader and intrareader and test-retest results demonstrated good-to-excellent reproducibility (interclass correlation coefficient range 0.61-0.98) for all magnetic resonance measures. The PAD participants (n=82) had lower capillary perfusion measured by calf muscle plasma volume (3.8% vs 5.6%) and peak hyperemic popliteal flow (4.1 vs 13.5mL/s) as compared with the healthy participants (n=16), with a significant level of collateralization. Reproducibility of the MRI primary end points in PACE was very good to excellent. The PAD participants exhibited decreased calf muscle capillary perfusion as well as arterial flow reserve when compared with healthy participants. The MRI tools used in PACE may advance PAD science by enabling accurate measurement of PAD microvascular anatomy and perfusion before and after stem cell or other PAD therapies.

Disruptions to habitual training routines are commonly due to injury or illness and can often lead to detraining adaptations. The implications of such adaptations to the human vasculature in a trained, asymptomatic population are not fully understood. To determine the extent of local and systemic changes in arterial diameter and blood flow to resistance training and subsequent detraining in young adults. Randomized controlled clinical trial. University physiology laboratory and fitness suite. Twenty-one healthy volunteers (aged 20.0 ± 2.8 years, 11 men and 10 women). Eight-week lower limb resistance training period and subsequent 4-week detraining period. Quadriceps and hamstrings concentric torque (strength), resting heart rate, arterial diameter, and blood flow velocity in the superficial femoral and carotid arteries were measured at 0, 8, 10, and 12 weeks. Resistance training increased quadriceps and hamstring strength (32% and 35%, respectively, P < .001), whereas strength decreased during detraining (24% and 27%, respectively, P < .05). Resting heart rate decreased after resistance training (16%, P < .01) and increased during detraining (19%, P < .001). Additionally, resistance training significantly increased superficial femoral and carotid resting arterial diameters (27% and 13%, respectively, P < .001) and mean blood flow (53% and 55%, respectively, P < .001). Detraining resulted in a significant decrease in superficial femoral and carotid resting diameter (46% and 10%, respectively, P < .001) and mean blood flow (61% and 38%, respectively, P < .05). Resistance training initiated both local and systemic changes to arterial diameter and blood flow; these changes appeared to reverse after detraining. The local changes in response to detraining showed a worsening (beyond pretraining values) of the vascular dimensional and blood flow characteristics.

Background and objectives: Regular exercise may stimulate bone formation and reduce the loss of bone mass in premenopausal women. This study aims to evaluate the effect of high-impact physical activity (Zumba®) and low-impact physical activity (Aquagym) on bone mass in inactive middle-aged women. Materials and methods: Fifty-five healthy inactive women (30–50 years old) were recruited in Spain in 2016 and were randomly allocated into one of three groups: High impact group (HIG: n = 15), low impact group (LIG: n = 12) and control group (CG: n = 28). HIG and LIG were recruited from Madrid and the CG from Toledo. HIG and LIG completed a 12-week intervention program with three 40′ sessions per week of Zumba® or Aquagym; respectively. Dual energy X-ray absorptiometry (DXA) measured bone mineral content (BMC) and areal bone mineral density (aBMD) at total body less head (TBLH), lumbar spine and right hip. Results: Post-intervention adjusted data showed no significant differences in BMC between any of the groups nor in aBMD between HIG and LIG. Interestingly; significant differences for the HIG vs. CG were found in the change in total hip aBMD (1.76% vs. −0.44%), femoral neck aBMD (1.80% vs. −2.71%), and intertrochanter aBMD (2.03% vs. −0.50%). Moreover, significant differences for the LIG vs. CG were also found in the change in femoral neck aBMD (−0.54% vs. −2.71%). Conclusions: The regular practice of Zumba® and Aquagym might reduce the progressive deterioration of bone mass in inactive middle-aged women

Study design: Randomized crossover. Objectives: To analyze the acute effects of isolated and simultaneous application of whole-body vibration (WBV) and electromyostimulation (ES) on popliteal artery blood velocity (BV) and skin temperature (ST) of the calf in subjects with spinal cord injury (SCI). Setting: Valladolid, Spain. Methods: Ten subjects with SCI were assessed in five different sessions. After a familiarization session, four interventions were applied in random order; WBV, ES, simultaneous WBV and ES (WBV+ES), and 30 s of WBV followed by 30 s of ES (WBV30/ES30). Each intervention consisted of 10 sets × 1 min ON+1 min OFF. Subjects were seated on their own wheelchairs with their feet on the vibration platform (10 Hz, 5 mm peak-to-peak), and ES was applied on the gastrocnemius muscle of both legs (8 Hz, 400 μs). Results: The simultaneous application (WBV+ES) produced the greatest increase in mean BV (MBV; 36% and 42%, respectively) and peak BV (PBV; 30% and 36%, respectively) during the intervention. This intervention produced the greatest mean increases in MBV (21%) and PBV (19%) during the recovery period. Last, this intervention produced the highest increase in ST during the intervention (2.1 °C). Conclusion: The simultaneous application of WBV+ES seems to produce a greater increase in MBV and PBV of the popliteal artery and ST of the calf than the isolated (WBV or ES) or consecutive application of both stimuli (WBV30/ES30). This study provides an efficient therapeutic methodology to improve peripheral arterial properties, which is pivotal in SCI patient’s rehabilitation.

ObjectiveCalf complex injuries represent a significant injury burden among Australian Rules athletes. To date, there has been limited research correlating clinical and radiological findings of pathology within the calf. The objective of this study is to determine how accurately magnetic resonance imaging (MRI) findings correlate with clinical measures of calf muscle complex pathology in elite male athletes.Materials and methodsA prospective cohort study was conducted on Australian rules elite athletes. A cohort of 45 athletes underwent a high-load training session of approximately 10 km of running. Athletes were then assessed by a sports physiotherapist who made a diagnosis of no pathology, delayed onset muscle soreness, strain or other. Subsequently, the athletes underwent MRI of their bilateral calf complexes. Radiologists interpreted the MRI findings and radiological diagnosis were correlated with clinical diagnosis.ResultsA total of 90 calf MRIs were performed. Correlation of clinical and radiological diagnosis occurred in 57 cases. Of the 33 cases which did not correlate, there were 4 radiologically significant acute calf strains in clinically asymptomatic athletes, 3 of which involved old scar tissue.ConclusionMRI may detect clinically insignificant injuries within the calf complex. If an athlete does not have any clinically relevant symptoms, abnormal signal on MRI may represent a different diagnosis to muscle strain. Signal change on MRI proximal to scar tissue may represent reactive oedema. Clinical history and examination should be correlated with radiological findings is recommended when diagnosing calf injury in elite athletes.

Background This study investigated the effect of different degrees of passive leg raising (PLR) on the internal jugular vein (IJV) cross-sectional area (CSA) and on the success rate of IJV cannulation in patients waiting for thoracic surgery, to analyze whether body mass index (BMI), gender, age, fasting time and preoperative rehydration have any impact on changes in the IJV CSA. Methods Eighty-two patients scheduled for selective thoracic surgery were enrolled in this study. Patients were randomly assigned based on a computer-generated randomization sequence into 3 groups: 0, 30, and 50 degrees ( n  = 32, 25, and 25 patients, respectively). The right IJV CSA in the sequence of 0-degree (supine position), 30-degree and 50-degree PLR positions was recorded in all patients using an ultrasound probe. The relationship of BMI, gender, age, fasting time and preoperative rehydration to the IJV CSA was analyzed. Then, each patient was returned to a supine position. After waiting for at least 5 min, patients were placed in a PLR position at 0, 30, or 50 degrees, and then IJV cannulation was performed without ultrasound guidance. The success rate of IJV catheterization at different PLR angles was compared. Results The average CSA of the right IJV in the supine position, 30-degree PLR position and 50-degree PLR position was 1.39 ± 0.63 cm 2 , 1.65 ± 0.73 cm 2 , and 1.68 ± 0.71 cm 2 , respectively. These results showed gradual increases in the IJV CSA of 18.5% (30-degree PLR) and 20.2% (50-degree PLR) when compared to that in the supine position ( P  = 0.045 and 0.025, respectively). However, only fasting time had a significant impact on the increase in the right IJV CSA at different PLR angles ( P  = 0.026). Other factors, such as BMI, gender, age and preoperative rehydration, had no significant effects. The success rates of IJV catheterization at angles of 0, 30 and 50 degrees were 84.3, 88 and 92%, respectively; however, there were no significant differences among the three groups ( P  = 0.674). Conclusions PLR increases the CSA of the right IJV, especially for patients with long fasting times before thoracic surgery. The effect of the 30-degree PLR position is similar to that of the 50-degree PLR position. However, the success rate of right IJV catheterization was not enhanced in this study using landmark-guided puncture, even though the CSA of the right IJV was increased. Trial registration Clinical trial registration number: ChiCTR1800015051 . Date of registration: March 2018.