Neuromuscular electrical stimulation after total joint arthroplasty: a critical review of recent controlled studies.

Since 2009, four randomized controlled trials have investigated the use of Neuromuscular Electrical Stimulation (NMES) as a treatment modality following total knee arthroplasty (TKA). Two of these studies demonstrated a treatment effect of NMES for improving physical function, while another study failed to find additional benefit of NMES relative to a progressive exercise intervention. The fourth study demonstrated non-inferiority of NMES compared supervised physical therapy. These studies differed substantially in their methodology, including the timing, duration, treatment volume and intensity of NMES interventions. The purpose of this review is to examine and discuss variations between these recent trials to synthesize the current state of evidence for NMES in post-TKA rehabilitation. When comparing intervention parameters across recent studies, it appears that high intensity NMES performed regularly during the immediate postoperative phase helped to attenuate dramatic losses in quadriceps strength following TKA, thereby resulting in overall improvements in strength and function.

Allurin, a 21-kDa sperm chemoattractant from Xenopus egg jelly, is related to mammalian sperm-binding proteins.

Previously, we demonstrated that a protein from Xenopus egg jelly exhibits sperm chemoattractant activity when assayed by either video microscopy or by sperm passage across a porous filter. Here we describe the isolation and purification of allurin, the protein responsible for this activity. Freshly oviposited jellied eggs were soaked in buffer, and the conditioned medium was loaded onto an anion exchange column and eluted with an NaCl gradient. The active fraction was purified further by RP-HPLC, the chemoattractant protein appearing as a single sharp peak. The amino acid sequence of the protein, determined by direct sequencing and cloning of cDNAs coding for the protein, consisted of 184 amino acids having a molecular mass of 21,073 Da. The protein shares homology with the mammalian cysteine-rich secretory protein (CRISP) family that includes testes-specific spermatocyte protein 1, a cell adhesion protein which links spermatocytes to Seritoli cells, and acidic epididymal glycoproteins that bind to sperm and have been implicated in sperm-egg fusion. Phylogenetic analysis suggests that allurin evolved from the ancestral protein that gave rise to the mammalian CRISP family. Addition of allurin to this family portends that the CRISP family represents a group of "sperm escort" proteins, which bind to sperm at various steps in their life history, facilitating passage from one functional stage to the next. Allurin stands out in this regard, representing both the first vertebrate sperm chemoattractant to be purified and sequenced and the first member of the CRISP family to be found in the female reproductive tract.