Suitable Heel Height, a Potential Method for Musculoskeletal Problems during the Third Trimester: A Pilot Study.

BACKGROUND: The treatment options for third-trimester musculoskeletal issues are limited. This study aims to examine how heel height affects gait biomechanics and provides heel height recommendations for various musculoskeletal problems. METHODS: Five third-trimester gravidas were recruited wearing uniform footwear with four heel heights (0 mm, 15 mm, 30 mm, and 45 mm). Lower-limb muscle forces, joint angles, joint torques, joint contact forces, and ground reaction forces (GRF) at specific moments (the first peak, valley, and second peak of GRF) were collected for one-way analysis of variance with repeated measures. RESULTS: The soleus, gastrocnemius, tibialis posterior, plantaris, obturator externus, gluteus maximus, gemellus superior, and obturator internus were the smallest at heel heights of 45 mm and 15 mm at the valley of GRF. Hip extension and knee flexion displayed the smallest joint angle and joint torques at a height of 15 mm. Ankle joint contact force decreased with increased heel height. CONCLUSIONS: The height of the heel significantly impacts muscle force, joint angles, joint torques, and joint contact force. A heel of 15 mm might be the most suitable heel height to potentially avoid or alleviate musculoskeletal problems during the third trimester.

Palladium-Catalyzed Asymmetric O-1,5-Addition with Oximes via Hydroximation of Unsaturated Esters.

Different from electronically matched 1,4- and 1,6-additions, herein, we disclose an electronically mismatched 1,5-conjugate addition process with oximes as the nucleophiles. By this design, the oxime moieties are readily introduced to the γ-position of the electron-deficient substrates in good yields, excellent regioselectivities, and high enantioselectivities. The corresponding allyl oximes are also conveniently transformed into a series of valuable enantioenriched skeletons.

Effects of prolonged brisk walking induced lower limb muscle fatigue on the changes of gait parameters in older adults.

BACKGROUND: Lower extremity muscle fatigue affects gait stability and increases the probability of injuries in the elderly. RESEARCH QUESTION: How does prolonged walking-induced fatigue affect lower limb muscle activity, plantar pressure distribution, and tripping risk? METHODS: Eighteen elderly adults walked fast on a treadmill for 60 minutes at a fixed speed. The plantar pressure was measured with an in-shoe monitoring system, eight lower limb muscles were monitored using surface electromyography, and foot movements were tracked by a motion capture analysis system. The above data and participants' subjective fatigue level feedback were collected every 5 minutes. Statistical analysis used the Friedman one-way repeated measures analysis of variance by ranks test followed by Wilcoxon signed-ranks test with Benjamini-Hochberg stepwise correction. RESULTS: The subjective reported fatigue on the Borg scale increased gradually from 1 to 6 (p = 0.001) during the 60 minutes, while the EMG amplitude of vastus medialis significant decreased (p = 0.013). The results of plantar pressure demonstrated that the distribution of load and impulse shifted medially in both the heel and arch regions while shifted laterally in both the toes and metatarsal regions. The significantly increased contact area supports this shift at the medial arch (p = 0.036, increased by 6.94%, the 60th minute vs. the baseline). The symmetry of medial-lateral plantar force increased at the toes, metatarsal, and arch regions. The significantly increased parameters also include the swing time and contact time. The minimum foot clearance was reduced, increasing tripping probability, not significantly, though. SIGNIFICANCE: This study facilitates a better understanding of changes in lower limb muscle activity and gait parameters during prolonged fast walking. Besides, this study has good guiding significance for developing smart devices based on plantar force, inertial measurement units, and EMG sensors to monitor changes in muscle activation in real-time and prevent tripping.

The Influence of Mattress Stiffness on Spinal Curvature and Intervertebral Disc Stress-An Experimental and Computational Study.

Sleeping support systems can influence spinal curvature, and the misalignment of the spinal curvature can lead to musculoskeletal problems. Previous sleep studies on craniocervical support focused on pillow variants, but the mattress supporting the pillow has rarely been considered. This study used a cervical pillow and three mattresses of different stiffnesses, namely soft, medium, and hard, with an indentation load deflection of 20, 42, and 120 lbs, respectively. A novel electronic curvature measurement device was adopted to measure the spinal curvature, whereby the intervertebral disc loading was computed using the finite element method. Compared with the medium mattress, the head distance increased by 30.5 ± 15.9 mm, the cervical lordosis distance increased by 26.7 ± 14.9 mm, and intervertebral disc peak loading increased by 49% in the soft mattress environment. Considering that the pillow support may increase when using a soft mattress, a softer or thinner pillow is recommended. The head distance and cervical lordosis distance in the hard mattress environment were close to the medium mattress, but the lumbar lordosis distance reduced by 10.6 ± 6.8 mm. However, no significant increase in intervertebral disc loading was observed, but contact pressure increased significantly, which could cause discomfort and health problems.

Different Design Feature Combinations of Flatfoot Orthosis on Plantar Fascia Strain and Plantar Pressure: A Muscle-Driven Finite Element Analysis With Taguchi Method.

Customized foot orthosis is commonly used to modify foot posture and relieve foot pain for adult acquired flexible flatfoot. However, systematic investigation of the influence of foot orthotic design parameter combination on the internal foot mechanics remains scarce. This study aimed to investigate the biomechanical effects of different combinations of foot orthoses design features through a muscle-driven flatfoot finite element model. A flatfoot-orthosis finite element model was constructed by considering the three-dimensional geometry of plantar fascia. The plantar fascia model accounted for the interaction with the bulk soft tissue. The Taguchi approach was adopted to analyze the significance of four design factors combination (arch support height, medial posting inclination, heel cup height, and material stiffness). Predicted plantar pressure and plantar fascia strains in different design combinations at the midstance instant were reported. The results indicated that the foot orthosis with higher arch support (45.7%) and medial inclination angle (25.5%) effectively reduced peak plantar pressure. For the proximal plantar fascia strain, arch support (41.8%) and material stiffness (37%) were strong influencing factors. Specifically, higher arch support and softer material decreased the peak plantar fascia strain. The plantar pressure and plantar fascia loading were sensitive to the arch support feature. The proposed statistics-based finite element flatfoot model could assist the insole optimization and evaluation for individuals with flatfoot.

Multicomponent Reaction of Isocyanide, Ditelluride, and Mn(III) Carboxylate: Synthesis of N-Acyl Tellurocarbamate.

A multicomponent reaction of isocyanides, ditellurides and manganese(III) carboxylates under mild reaction conditions leads to the synthesis of various N-acyl tellurocarbamates. This method demonstrates good functional tolerance and broad substrate scope and, as a result, is especially suitable for the postfunctionalization of complicated molecules such as drugs. The given method can be further extended to the synthesis of selenocarbamates.

Changes in segment coordination variability and the impacts of the lower limb across running mileages in half marathons: Implications for running injuries.

BACKGROUND: Segment coordination variability (CV) is a movement pattern associated with running-related injuries. It can also be adversely affected by a prolonged run. However, research on this topic is currently limited. The purpose of this study was to investigate the effects of a prolonged run on segment CV and vertical loading rates during a treadmill half marathon. METHODS: Fifteen healthy runners ran a half marathon on an instrumental treadmill in a biomechanical laboratory. Synchronized kinematic and kinetic data were collected every 2 km (from 2 km until 20 km), and the data were processed by musculoskeletal modeling. Segment CVs were computed from the angle-angle plots of selected pelvis-thigh, thigh-shank, and shank-rearfoot couplings using a modified vector coding technique. The loading rate of vertical ground reaction force was also calculated. A one-way MANOVA with repeated measures was performed on each of the outcome variables to examine the main effect of running mileage. RESULTS: Significant effects of running mileage were found on segment CVs (p ≤ 0.010) but not on loading rate (p = 0.881). Notably, during the early stance phase, the CV of pelvis frontal vs. thigh frontal was significantly increased at 20 km compared with the CV at 8 km (g = 0.59, p = 0.022). The CV of shank transverse vs. rearfoot frontal decreased from 2 km to 8 km (g = 0.30, p = 0.020) but then significantly increased at both 18 km (g = 0.05, p < 0.001) and 20 km (g = 0.36, p < 0.001). CONCLUSION: At the early stance, runners maintained stable CVs on the sagittal plane, which could explain the unchanged loading rate throughout the half marathon. However, increased CVs on the frontal/transverse plane may be an early sign of fatigue and indicative of possible injury risk. Further studies are necessary for conclusive statements in this regard.

Synthesis of Poly-Substituted Pyridines via Noble-Metal-Free Cycloaddition of Ketones and Imines.

An eco-friendly and noble-metal-free formal [4+2] cycloaddition reaction was developed for the efficient synthesis of biologically interesting poly-substituted pyridines from easily available ketones and imines, whereby two sequential C-C bonds are formed. The given approach features a unique synthetic strategy of imines and ketones with wide substrate scope, good functional group tolerance, mild conditions and operational simplicity, which represents a more direct pathway to synthesize poly-substituted pyridines than traditional methods.

Biomechanical comparison among five mid/hindfoot arthrodeses procedures in treating flatfoot using a musculoskeletal multibody driven finite element model.

BACKGROUND AND OBJECTIVE: Mid/hindfoot arthrodesis could modify the misalignment of adult-acquired flatfoot and attenuate pain. However, the long-term biomechanical effects of these surgical procedures remain unclear, and the quantitative evidence is scarce. Therefore, we aimed to investigate and quantify the influences of five mid/hindfoot arthrodeses on the internal foot biomechanics during walking stance. METHODS: A young participant with flexible flatfoot was recruited for this study. We reconstructed a subject-specific musculoskeletal multibody driven-finite element (FE) foot model based on the foot magnetic resonance imaging. The severe flatfoot model was developed from the flexible flatfoot through the attenuation of ligaments and the unloading of the posterior tibial muscle. The five mid/hindfoot arthrodeses simulations (subtalar, talonavicular, calcaneocuboid, double, and triple arthrodeses) and a control condition (no arthrodesis) were performed simultaneously in the detailed foot multibody dynamics model and FE model. Muscle forces calculated by a detailed multi-segment foot model and ground reaction force were used to drive the foot FE model. The internal foot loadings were compared among control and these arthrodeses conditions at the first and second vertical ground reaction force (VGRF) peak and VGRF valley instants. RESULTS: The results indicated that the navicular heights in double and triple arthrodeses were higher than other surgical procedures, while the subtalar arthrodesis had the smallest values. Five mid/hindfoot arthrodeses reduced the peak plantar fascia stress compared to control. However, double and triple arthrodeses increased the peak medial cuneo-navicular joint contact pressures and peak foot pressures as well as the metatarsal bones stresses. CONCLUSION: Although mid/hindfoot arthrodesis generally reduced the collapse of medial longitudinal arch and plantar fascia loading during the stance phase, the increased loading in the adjacent unfused joint and metatarsal bones for double and triple arthrodeses should be noted. These findings could account for some symptoms experienced by flatfoot patients after surgery, which may facilitate the optimization of surgical protocols.

Plantar Pressure Variability and Asymmetry in Elderly Performing 60-Minute Treadmill Brisk-Walking: Paving the Way towards Fatigue-Induced Instability Assessment Using Wearable In-Shoe Pressure Sensors.

Evaluation of potential fatigue for the elderly could minimize their risk of injury and thus encourage them to do more physical exercises. Fatigue-related gait instability was often assessed by the changes of joint kinematics, whilst planar pressure variability and asymmetry parameters may complement and provide better estimation. We hypothesized that fatigue condition (induced by the treadmill brisk-walking task) would lead to instability and could be reflected by the variability and asymmetry of plantar pressure. Fifteen elderly adults participated in the 60-min brisk walking trial on a treadmill without a pause, which could ensure that the fatigue-inducing effect is continuous and participants will not recover halfway. The plantar pressure data were extracted at baseline, the 30th minute, and the 60th minute. The median of contact time, peak pressure, and pressure-time integrals in each plantar region was calculated, in addition to their asymmetry and variability. After 60 min of brisk walking, there were significant increases in peak pressure at the medial and lateral arch regions, and central metatarsal regions, in addition to their impulses (p < 0.05). In addition, the variability of plantar pressure at the medial arch was significantly increased (p < 0.05), but their asymmetry was decreased. On the other hand, the contact time was significantly increased at all plantar regions (p < 0.05). The weakened muscle control and shock absorption upon fatigue could be the reason for the increased peak pressure, impulse, and variability, while the improved symmetry and prolonged plantar contact time could be a compensatory mechanism to restore stability. The outcome of this study can facilitate the development of gait instability or fatigue assessment using wearable in-shoe pressure sensors.

Extrinsic foot muscle forces and joint contact forces in flexible flatfoot adult with foot orthosis: A parametric study of tibialis posterior muscle weakness.

BACKGROUND: The posterior tibialis tendon dysfunction (PTTD) is typically associated with progressive flatfoot deformity, which could be alleviated with foot orthosis. However, the evaluation of tibialis posterior (TP) weakness on lower limb mechanics of flatfoot adults with foot orthoses is scarce and requires further investigation. RESEARCH QUESTION: This study aimed to examine the effects of TP weakness on lower limb mechanics in flatfoot adults with foot orthosis through gait analysis and musculoskeletal modelling. METHODS: Fifteen young adults with flatfoot were recruited from University to perform a gait experiment with and without foot orthoses. Data collected from the motion capture system were used to drive the musculoskeletal modelling for the estimation of the joint force and extrinsic muscle forces of the lower limb. A parametric analysis was conducted by adjusting the TP muscle strength from 40 % to 100 %. Two-way repeated measures ANOVA was used to compare the peak extrinsic foot muscle forces and joint forces among different levels of TP weakness and insole conditions. RESULTS: TP weakness significantly increased ankle joint force superoinferiorly (F = 125.9, p < 0.001) and decreased anteroposteriorly (F = 125.9, p < 0.001), in addition to a significant increase in the muscle forces of flexor hallucis longus (p < 0.001) and flexor digitorum longus (p < 0.001). Besides, the foot orthosis significantly reduced most peak muscle forces whilst significantly reduced the second peak knee force and peak ankle force compared to the control condition (F = 8.79-30.9, p < 0.05). SIGNIFICANCE: The increased extrinsic foot muscle forces (flexor hallucis longus and flexor digitorum longus) and ankle joint forces in the TP weakness condition indicated that TP weakness may induce compensatory muscle activation and attenuated joint load. The abnormal muscle and joint mechanics in flatfoot adults with TP weakness might be restored by the orthosis.

PdCl2/DMSO-Catalyzed Thiol-Disulfide Exchange: Synthesis of Unsymmetrical Disulfide.

Unsymmetrical disulfides have been effectively prepared through thiol exchange with symmetrical disulfides employing a simple PdCl2/DMSO catalytic system. The given method features excellent functional group tolerance, a broad substrate scope, and operational simplicity. This reaction is especially useful for late-stage functionalization of bioactive scaffolds such as peptides and pharmaceuticals. Disulfide-containing organic dyes have also been prepared. This transformation could be extended to thiol-diselenide or thiol-ditelluride exchange affording RS-SeR' or RS-TeR'.

Spectral Analysis of Muscle Hemodynamic Responses in Post-Exercise Recovery Based on Near-Infrared Spectroscopy.

Spectral analysis of blood flow or blood volume oscillations can help to understand the regulatory mechanisms of microcirculation. This study aimed to explore the relationship between muscle hemodynamic response in the recovery period and exercise quantity. Fifteen healthy subjects were required to perform two sessions of submaximal plantarflexion exercise. The blood volume fluctuations in the gastrocnemius lateralis were recorded in three rest phases (before and after two exercise sessions) using near-infrared spectroscopy. Wavelet transform was used to analyze the total wavelet energy of the concerned frequency range (0.005-2 Hz), which were further divided into six frequency intervals corresponding to six vascular regulators. Wavelet amplitude and energy of each frequency interval were analyzed. Results showed that the total energy raised after each exercise session with a significant difference between rest phases 1 and 3. The wavelet amplitudes showed significant increases in frequency intervals I, III, IV, and V from phase 1 to 3 and in intervals III and IV from phase 2 to 3. The wavelet energy showed similar changes with the wavelet amplitude. The results demonstrate that local microvascular regulators contribute greatly to the blood volume oscillations, the activity levels of which are related to the exercise quantity.

Identifying Fatigue Indicators Using Gait Variability Measures: A Longitudinal Study on Elderly Brisk Walking.

Real-time detection of fatigue in the elderly during physical exercises can help identify the stability and thus falling risks which are commonly achieved by the investigation of kinematic parameters. In this study, we aimed to identify the change in gait variability parameters from inertial measurement units (IMU) during a course of 60 min brisk walking which could lay the foundation for the development of fatigue-detecting wearable sensors. Eighteen elderly people were invited to participate in the brisk walking trials for 60 min with a single IMU attached to the posterior heel region of the dominant side. Nine sets of signals, including the accelerations, angular velocities, and rotation angles of the heel in three anatomical axes, were measured and extracted at the three walking times (baseline, 30th min, and 60th min) of the trial for analysis. Sixteen of eighteen participants reported fatigue after walking, and there were significant differences in the median acceleration (p = 0.001), variability of angular velocity (p = 0.025), and range of angle rotation (p = 0.0011), in the medial-lateral direction. In addition, there were also significant differences in the heel pronation angle (p = 0.005) and variability and energy consumption of the angles in the anterior-posterior axis (p = 0.028, p = 0.028), medial-lateral axis (p = 0.014, p = 0.014), and vertical axis (p = 0.002, p < 0.001). Our study demonstrated that a single IMU on the posterior heel of the dominant side can address the variability of kinematics parameters for elderly performing prolonged brisk walking and could serve as an indicator for walking instability, and thus fatigue.

Clinical significance of CC16 and IL-12 in bronchoalveolar lavage fluid of various stages of silicosis.

BACKGROUND: Identification of novel biomarkers for silicosis could be helpful for disease diagnosis and pathophysiological mechanism exploration. Our study aims to investigate the Clara cell secretory 16-kd protein (CC16) and interleukin-12 (IL-12) levels in bronchoalveolar lavage fluid (BALF) in patients with silicosis at various stages. METHODS: The enzyme-linked immunosorbent assay (ELISA) double antibody sandwich method was used to determine the CC16 and IL-12 in BALF levels from 79 patients with silicosis of various stages. Correlation analyses were performed between CC16 and IL-12 levels, and lung function and cytological counts in patients with silicosis at various stages. RESULTS: There were no significant differences in the BALF recovery volume, the number of cells, percentages of macrophages and lymphocytes in the alveolar lavage fluid of patients with silicosis in different stages (P>0.05); the percentage of neutrophils in stage I and stage II were higher than the control group (P<0.05) with statistically significant differences. The CC16 in BALF levels in stage I and II silicosis groups lower than the control group and stage III silicosis group with statistically significant differences (P<0.05), whereas CC16 levels in stage II silicosis group are higher than the stage I group (P<0.01). The IL-12 levels were higher than the control group (P<0.01), and the IL-12 levels in stage II and III silicosis group was higher than the stage I silicosis group (P<0.01). With the increase of the length of dust service, the CC16 and IL-12 levels decreased and showed a positive correlation between these indexes (correlation coefficient r=0.559, P<0.01). In addition, CC16 silicosis patient levels were positively correlated with FEV1/FVC and VCmax (r=0.242, 0.257; both P<0.05); IL-12 levels were negatively correlated with FEV1 and VC max (r=-0.250, -0.483; both P<0.05). CONCLUSIONS: The CC16 and IL-12 levels may have a specific reference value for the early diagnosis of silicosis and the assessment of lung function.

Finite Element Analysis of Generalized Ligament Laxity on the Deterioration of Hallux Valgus Deformity (Bunion).

Hallux valgus is a common foot problem affecting nearly one in every four adults. Generalized ligament laxity was proposed as the intrinsic cause or risk factor toward the development of the deformity which was difficult to be investigated by cohort clinical trials. Herein, we aimed to evaluate the isolated influence of generalized ligament laxity on the deterioration using computer simulation (finite element analysis). We reconstructed a computational foot model from a mild hallux valgus participant and conducted a gait analysis to drive the simulation of walking. Through parametric analysis, the stiffness of the ligaments was impoverished at different degrees to resemble different levels of generalized ligament laxity. Our simulation study reported that generalized ligament laxity deteriorated hallux valgus by impairing the load-bearing capacity of the first metatarsal, inducing higher deforming force, moment and malalignment at the first metatarsophalangeal joint. Besides, the deforming moment formed a deteriorating vicious cycle between hallux valgus and forefoot abduction and may result in secondary foot problems, such as flatfoot. However, the metatarsocuneiform joint did not show a worsening trend possibly due to the overriding forefoot abduction. Controlling the deforming load shall be prioritized over the correction of angles to mitigate deterioration or recurrence after surgery.

Immediate Effects of Medially Posted Insoles on Lower Limb Joint Contact Forces in Adult Acquired Flatfoot: A Pilot Study.

Flatfoot is linked to secondary lower limb joint problems, such as patellofemoral pain. This study aimed to investigate the influence of medial posting insoles on the joint mechanics of the lower extremity in adults with flatfoot. Gait analysis was performed on fifteen young adults with flatfoot under two conditions: walking with shoes and foot orthoses (WSFO), and walking with shoes (WS) in random order. The data collected by a vicon system were used to drive the musculoskeletal model to estimate the hip, patellofemoral, ankle, medial and lateral tibiofemoral joint contact forces. The joint contact forces in WSFO and WS conditions were compared. Compared to the WS group, the second peak patellofemoral contact force (p < 0.05) and the peak ankle contact force (p < 0.05) were significantly lower in the WSFO group by 10.2% and 6.8%, respectively. The foot orthosis significantly reduced the peak ankle eversion angle (p < 0.05) and ankle eversion moment (p < 0.05); however, the peak knee adduction moment increased (p < 0.05). The reduction in the patellofemoral joint force and ankle contact force could potentially inhibit flatfoot-induced lower limb joint problems, despite a greater knee adduction moment.

Silver-Assisted Oxidative Isocyanide Insertion of Ethers: A Direct Approach to ß-Carbonyl α-Iminonitriles.

An efficient silver-assisted oxidative coupling of simple ethers with tert-butyl isocyanide was realized in the presence of DDQ. The direct synthesis of high density functional ß-carbonyl α-iminonitriles was achieved in a single step with high yields through the synergetic cascade isocyanide insertion into C(sp3)-H bond, where the isocyanide was used as crucial "CN" and "C═N" sources and the tert-butoxyl group acted as the carbonyl source. Diverse reactivity of ß-carbonyl α-iminonitriles has been demonstrated.