Diagnostic criteria, prevalence, and clinical outcomes of pediatric sarcopenia: A scoping review.

BACKGROUND & AIMS: Sarcopenia, characterized by loss of muscle mass and decreased muscle strength, significantly affects adults but also influences pediatric health. However, definitions for low muscle mass, decreased strength, and sarcopenia in children are less established, impacting interventions for improving health outcomes. The objective of this scoping review is synthesize the existing literature on the diagnostic criteria, prevalence and clinical outcomes of sarcopenia. METHODS: A scoping review, following the PRISMA extension for scoping reviews, examined pediatric sarcopenia literature until June 2023. The literature search was performed using MEDLINE and the Cochrane Central Register of Controlled Trials with the last search conducted on June 30, 2023. Criteria included studies on aged 0-20 years, covering healthy subjects, acutely ill patients, and chronic disease cases excluding specific conditions like neuromuscular diseases or prematurity. RESULTS: Initial search found 503 studies, finally, we included 56 studies. Most studies diagnosed sarcopenia using skeletal muscle mass indicators like total psoas muscle area from Computed Tomography or Magnetic Resonance Imaging. Around half of the longitudinal studies highlighted sarcopenia as a risk factor for various clinical outcomes, predominantly in hospitalized patients. However, cutoff values for sarcopenia indicators lacked consistency, with studies employing diverse percentile-based measurements or z-scores. CONCLUSION: Pediatric sarcopenia diagnosis primarily relies on skeletal muscle mass, with identified links to future clinical outcomes in specific conditions. The lack of standardized cutoffs for sarcopenia indicators underscores the necessity for age, gender, and race-specific cutoff values derived from studies establishing reference values for muscle mass and strength across diverse pediatric populations.

Improving physicomechanical properties of arrowroot starch films incorporated with kappa-carrageenan: Sweet cherry coating application.

Arrowroot starch (AS)-based films potential is influenced by its low-cost processing and high transparency packaging material but low tensile strength; hence, AS was blended with kappa-carrageenan (KC) to improve mechanical properties of AS-based films and enhance its potential use in food packaging or coating applications. AS-KC-based films were characterized based on structural, physicomechanical, thermal, pasting properties, and coating application in sweet cherry. The films demonstrated high tensile strength from 3.2 to 29.4 MPa and low elongation properties from 160.3 % to 1.9 %. Moreover, AS/KC films exhibited peak viscosities of 18.7 to 34.8 RVU, and thermal analysis depicted lower weight losses (59-45 %) compared to AS-based films (62 %). In addition, sweet cherry samples coated with AS/KC films and stored at 20 °C for 15 days depicted lower weight losses (26.6 %) compared to non-coated samples (>41 %), which indicated the potential use of the film's coating application in extending the shelf life and quality of fresh fruits.

Early Predictors of Recovery From Nonoperatively Treated Achilles Tendon Rupture: 1 Year Follow-Up Study.

PURPOSE: To investigate early structural and mechanical predictors of plantarflexor muscle strength and the magnitude of Achilles tendon (AT) nonuniform displacement at 6 and 12 months after AT rupture. METHODS: Thirty-five participants (28 males and 7 females; mean ± SD age 41.7 ± 11.1 years) were assessed for isometric plantarflexion maximal voluntary contraction (MVC) and AT nonuniformity at 6 and 12 months after rupture. Structural and mechanical AT and plantarflexor muscle properties were measured at 2 months. Limb asymmetry index (LSI) was calculated for all variables. Multiple linear regression was used with the 6 and 12 month MVC LSI and 12 month AT nonuniformity LSI as dependent variables and AT and plantarflexor muscle properties at 2 months as independent variables. The level of pre- and post-injury sports participation was inquired using Tegner score at 2 and 12 months (scale 0-10, 10 = best possible score). Subjective perception of recovery was assessed with Achilles tendon total rupture score (ATRS) at 12 months (scale 0-100, 100=best possible score). RESULTS: Achilles tendon resting angle (ATRA) symmetry at 2 months predicted MVC symmetry at 6 and 12 months after rupture (ß = 2.530, 95% CI 1.041-4.018, adjusted R2 = 0.416, p = 0.002; ß = 1.659, 95% CI 0.330-2.988, adjusted R2 = 0.418, p = 0.016, respectively). At 12 months, participants had recovered their pre-injury level of sports participation (Tegner 6 ± 2 points). The median (IQR) ATRS score was 92 (7) points at 12 months. CONCLUSION: Greater asymmetry of ATRA in the early recovery phase may be a predictor of plantarflexor muscle strength deficits up to 1 year after rupture. TRIAL REGISTRATION: This research is a part of "nonoperative treatment of Achilles tendon rupture in Central Finland: a prospective cohort study" that has been registered in ClinicalTrials.gov (NCT03704532).

Eggshell membrane and green seaweed (Ulva lactuca) micronized powders for in vivo diabetic wound healing in albino rats: a comparative study.

BACKGROUND: Nonhealing diabetic wounds are a serious complication associated with extremely lethargic wound closure and a high risk of infection, leading to amputation or limb loss, as well as substantial health care costs and a poor quality of life for the patient. The effects of either eggshell membrane (ESM) and green seaweed (Ulva lactuca) extracts alone or in combination were evaluated for in vivo skin wound healing in a rat model of induced diabetes. METHODS: Micronized powders of waste hen ESM, Ulva lactuca, and their 1:1 mixture were prepared using regular procedures. The mechanical, electrical, and surface morphology characteristics of powders were examined using direct compression, LCR-impedancemetry, and scanning electron microscopy. The effect of ESM, Ulva lactuca, and their mixture as compared to standard Dermazin treatments were evaluated on wounds inflicted on male Wistar Albino rats with induced diabetes. Quantitative wound healing rates at baseline and at 3, 7, 14, and 21 days of treatments among all rat groups were conducted using ANOVA. Qualitative histological analysis of epidermal re-epithelization, keratinocytes, basement membrane, infiltrating lymphocytes, collagen fibrines, and blood vessels at day 21 were performed using Image J processing program. RESULTS: Compressive strength measurements of tablets showed a Young's modulus of 44.14 and 27.17 MPa for the ESM and ESM + Ulva lactuca mixture, respectively. Moreover, both samples exhibited relatively low relative permittivity values of 6.62 and 6.95 at 1 MHz, respectively, due to the porous surface morphology of ESM shown by scanning electron microscopy. On day 21, rats treated with ESM had a complete diabetic wound closure, hair regrowth, and a healing rate of 99.49%, compared to 96.79% for Dermazin, 87.05% for Ulva lactuca, 90.23% for the mixture, and only 36.44% for the negative controls. A well-formed basement membrane, well-differentiated epithelial cells, and regular thick keratinocytes lining the surface of the epidermal cells accompanied wound healing in rats treated with ESM, which was significantly better than in control rats. CONCLUSION: Ground hen ESM powder, a low-cost effective biomaterial, is better than Ulva lactuca or their mixture for preventing tissue damage and promoting diabetic wound healing, in addition to various biomedical applications.

Photoactivated rose bengal-doped TiO2 nanoparticles modified fifth-generation adhesive on the survival rate of Streptococcus mutants and mechanical properties of tooth-colored restorative material to carious dentin.

Assessment of the antimicrobial, micro tensile bond strength (µTBS), and degree of conversion (DC) of fifth-generation adhesive modified using photoactivated 0.5% rose bengal (RB) and photoactivated RB-doped titanium dioxide nanoparticles (TiO2NPs) in different concentrations (2% and 5%) as compared with the unmodified adhesive bonded to the carious affected dentin (CAD). Forty mandibular molars with caries progression up to the middle third of the dentin, as per the International Caries Detection and Assessment System (ICDAS) score of 4 and 5 were included. Specimens were divided into four groups based on etch and rinse adhesive (ERA) modification group 1: unmodified ERA, group 2: photoactivated 0.5% RB photosensitizer (PS) modified ERA, group 3: photoactivated RB-doped 2 wt% TiO2NPs adhesive, group 4: photoactivated RB-doped 5 wt% TiO2NPs adhesive. Followed by adhesive and composite restoration on the CAD surface. All the specimens were thermocycled and an assessment of µTBS and failure pattern analysis was performed. The antibacterial potency of RB and RB-doped TiO2NPs (2% and 5%) followed by their activation using visible light against Streptococcus mutans (S.mutans) were tested. The survival rate of S.mutans was assessed using the Kruskal-Wallis test. The analysis of µTBS involved the use of ANOVA, followed by a post-hoc Tukey honestly significant difference (HSD) multiple comparisons test. Group 1 (Unmodified ERA) (0.52 ± 0.31 CFU/mL) treated samples unveiled the highest means of bacterial survival and lowest µTBS (11.32 ± 0.63 MPa). Nevertheless, group 4: photoactivated RB-doped 5 wt% TiO2NPs adhesive displayed the lowest outcomes of S.mutans survival (0.11 ± 0.02 CFU/mL) and highest bond strength (18.76 ± 1.45 MPa). The photoactivated RB-doped 2 wt% TiO2NPs in adhesive demonstrated promising enhancements in both µTBS and antibacterial efficacy against S.mutans. However, it is noteworthy that this modification led to a decrease in the DC of the adhesive. RESEARCH HIGHLIGHTS: Unmodified ERA-treated samples unveiled the highest bacterial survival and the lowest µTBS. Photoactivated RB-doped 5 wt% TiO2NPs adhesive displayed the lowest S.mutans survival rate and highest bond strength. DC decreased with an increase in concentration of TiO2.

Unveiling the influence of hip isokinetic strength on lower extremity running kinematics in male national middle-distance runners: a correlational analysis.

BACKGROUND: The relationship between hip strength deficiency in various planes and musculoskeletal injuries within the movement system has been well-established in numerous studies. The present study sought to explore the relationships between hip strength and specific aspects of lower extremity running kinematics. METHODOLOGY: To achieve this objective, the three-dimensional running kinematics of 21 male elite middle-distance runners (mean age: 19.7 ± 1.2 years; mean experience 6.5 ± 1.0 years) were assessed using nine high-speed cameras on a treadmill at a speed of 16 km·h⁻¹. Concurrently, isokinetic hip strength was measured at a speed of 60 deg·s⁻¹ in both the dominant and non-dominant legs. The Pearson correlation coefficient and Paired Samples t-test were utilized. RESULTS: While no significant differences were found in several isokinetic strength measurements, notable differences in running kinematics were observed. Specifically, pelvic drop at midstance (MS) was significantly lower in the DL (5.79 ± 3.00°) compared to the NDL (8.71 ± 1.39°) with a large effect size (t=-4.04, p < 0.001, Cohen's d = 1.25). Additionally, knee adduction at maximum showed a moderate effect size difference, with the DL at 2.99 ± 1.13° and the NDL at 3.81 ± 1.76° (t=-2.74, p = 0.03, Cohen's d = 0.55). Results indicated a moderate to highly positive association between running knee adduction in the dominant leg and hip external rotation (r = 0.67, p < 0.05), concentric extension (r = 0.77, p < 0.05), and concentric abduction (r = 0.78, p < 0.05). Additionally, the running tibial external rotation angle in the dominant leg exhibited an inverse relationship with all strength measurements, with statistical significance observed only for concentric extension force (r=-0.68, p < 0.05). Furthermore, hip internal rotation force demonstrated a highly inverse correlation with foot pronation in the dominant leg (r=-0.70, p < 0.05) and anterior pelvic tilt in the non-dominant leg (r=-0.76, p < 0.05). CONCLUSIONS: These findings underscore the interrelation between hip strength and running kinematics, particularly on the dominant side. In light of these observations, it is imperative to consider hip strength exercises as integral components for correcting running kinematics. Coaches should also be mindful that kinematic deviations contributing to running injuries may manifest unilaterally or specifically in the dominant leg.

Optimizing exercise prescription during breast cancer rehabilitation in women: Analysis of the load-velocity relationship in the box squat exercise.

The aims of this study were to assess (i) the load-velocity relationship during the box squat exercise in women survivors of breast cancer, (ii) which velocity variable (mean velocity [MV], mean propulsive velocity [MPV], or peak velocity [PV]) shows stronger relationship with the relative load (%1RM), and (iii) which regression model (linear [LA] or polynomic [PA]) provides a greater fit for predicting the velocities associated with each %1RM. Nineteen women survivors of breast cancer (age: 53.2 ± 6.9 years, weight: 70.9 ± 13.1 kg, and height: 163.5 ± 7.4 cm) completed an incremental load test up to one-repetition maximum in the box squat exercise. The MV, MPV, and the PV were measured during the concentric phase of each repetition with a linear velocity transducer. These measurements were analyzed by regression models using LA and PA. Strong correlations of MV with %1RM (R2 = 0.903/0.904; the standard error of the estimate (SEE) = 0.05 m.s-1 by LA/PA) and MPV (R2 = 0.900; SEE = 0.06 m.s-1 by LA and PA) were observed. In contrast, PV showed a weaker association with %1RM (R2 = 0.704; SEE = 0.15 m.s-1 by LA and PA). The MV and MPV of 1RM was 0.22 ± 0.04 m·s-1, whereas the PV at 1RM was 0.63 ± 0.18 m.s-1. These findings suggest that the use of MV to prescribe relative loads during resistance training, as well as LA and PA regression models, accurately predicted velocities for each %1RM. Assessing and prescribing resistance exercises during breast cancer rehabilitation can be facilitated through the monitoring of movement velocity.

Resistance exercise training to improve post-operative rehabilitation in knee arthroplasty patients: A narrative review.

Knee osteoarthritis is associated with deficits in muscle strength, muscle mass, and physical functioning. These muscle-related deficits are acutely exacerbated following total knee arthroplasty (TKA) and persist long after surgery, despite the application of standardized rehabilitation programs that include physical/functional training. Resistance exercise training (RET) has been shown to be a highly effective strategy to improve muscle-related outcomes in healthy as well as clinical populations. However, the use of RET in traditional rehabilitation programs after TKA is limited. In this narrative review, we provide an updated view on whether adding RET to the standard rehabilitation (SR) in the recovery period (up to 1 year) after TKA leads to greater improvements in muscle-related outcomes when compared to SR alone. Overall, research findings clearly indicate that both muscle strength and muscle mass can be improved to a greater extent with RET-based rehabilitation compared to SR. Additionally, measures of physical functioning that rely on quadriceps strength and balance (e.g., stair climbing, chair standing, etc.) also appear to benefit more from a RET-based program compared to SR, especially in patients with low levels of physical functioning. Importantly though, for RET to be optimally effective, it should be performed at 70%-80% of the one-repetition maximum, with 3-4 sets per exercise, with a minimum of 3 times per week for 8 weeks. Based upon this narrative review, we recommend that such high-intensity progressive RET should be incorporated into standard programs during rehabilitation after TKA.

Facilitating and hindering factors for routine adaptations in manufacturing and effects on human performance- unexpected insights from three experimental studies in a special purpose setting.

Consumer behaviour changes and strategic management decisions are driving adaptations in manufacturing routines. Based on the theory of situational strength, we investigated how contextual and person-related factors influence workers' adaptation in a two-worker position routine. Contextual factors, like retrieval cues (Study 1), time pressure (Study 2), and convenience (Study 3), were varied. Person-related factors included retentivity, general and routine-specific self-efficacy, and perceived adaptation costs. Dependent variables included various error types and production time before and after adaptation. In each study, 148 participants were trained in a production routine at t1 and executed an adapted routine at t2, one week later. Repeated measures ANOVA for performance at t1 and t2, and MANOVA for performance at t2, revealed that time increased for all groups at t2. For participants in Studies 1 & 2, error rates remained consistent. Retentivity significantly impacted errors at both t1 and t2, emphasising that routine changes in a 'running business' take time, regardless of contextual factors. Workers with lower retentivity may require additional support.

When production routines are changed while daily business operations continue, and on-the-job training is the sole method, a slowdown in production speed should be anticipated. Workers, particularly those with low retentivity, require additional support and training to minimise errors when executing the adapted routine.

Association Between Dietary Acid Load and Grip Strength in Adults 50 Years and Older: A Cross-Sectional Study.

Minimal data exist on whether the acid-base balance of the diet is linked to muscle strength. The aim of this study was to determine if dietary acid load is associated with grip strength in a nationally representative sample of middle- to older-age adults. We examined the cross-sectional association of grip strength with dietary acid load quantified through potential renal acid load (PRAL) and net endogenous acid production (NEAP) in 4,059 adults aged 50 years and older in the 2011-2014 NHANES survey cycles. PRAL and NEAP were estimated from two 24-h recalls and categorized into sex-specific quartiles. Grip strength was measured on a dynamometer. Multiple linear regression models were used to determine the associations of PRAL and NEAP (as quartiles) with grip strength for men and women separately, adjusting for total energy, age, race/ethnicity, weight, physical activity, smoking, serum 25-hydroxyvitamin D, and estimated glomerular filtration rate. Mean grip strength was 26.8 ± 0.2 kg in women and 43.0 ± 0.4 kg in men. Adjusted grip strength was inversely associated with quartiles of PRAL (ptrend = 0.049) and NEAP (ptrend = 0.034) in women with quartile 4 vs 1 differences of - 1.21 and - 1.08 kg (both p < 0.05), respectively. Adjusted grip strength was not associated with PRAL or NEAP in men. Overall, we found inverse associations between dietary acid load and grip strength in middle- and older-age women, suggesting that an alkaline diet may be important in maintaining muscle strength in this population. There was no association between dietary acid load and grip strength in men.

Mechanical performance and anisotropic analysis of rubberised 3D-printed concrete incorporating PP fibre.

The research investigates the effects of substituting sand with rubber particles derived from waste tyres-up to 40% by volume-and the inclusion of polypropylene (PP) fibres. Unlike steel fibres, which can cause operational challenges and surface irregularities in the printing process, PP fibres' flexibility integrates well within the concrete matrix. This integration ensures smooth extrusion and a high-quality surface finish, enhancing the printability of the concrete. The study's findings reveal that including rubber particles and PP fibres impacts the concrete's properties, showing a general decline in compressive and flexural strengths as the rubber content increases. Nevertheless, the PP fibre-enhanced mixtures maintain sufficient structural strength, demonstrating an anisotropic compressive strength above 30 MPa and a flexural strength of 4 MPa. These results underscore the feasibility of using rubberised 3D-printed concrete with PP fibres in sustainable construction practices, aligning with standards (ACI 318:2018) and contributing to eco-friendly and innovative construction methodologies.

Investigating the impact of surface treatments on tensile bond strength between pediatric prefabricated zirconia crowns and primary maxillary incisors with various types of luting cement: an in vitro study.

PURPOSE: This study aimed to evaluate the effects of two surface treatments on the tensile bond strength of prefabricated zirconia crowns (PZCs) using bioactive and resin cements. METHODS: Forty extracted human primary maxillary incisors were prepared and divided into four groups based on surface treatment and cement type: (1) sandblast with bioactive cement, (2) sandblast with resin cement, (3) 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) with bioactive cement, and (4) 10-MDP with resin cement. After 24 h of cementation, specimens underwent 5000 thermocycling cycles between 5 °C and 55 °C. Tensile bond strengths were measured using a universal testing machine. The data were analyzed using two-way ANOVA and Tukey's post hoc test, with significance set at p < 0.05. RESULTS: The mean tensile bond strengths observed were 2.25 ± 1.27 MPa for sandblast with bioactive cement, 1.39 ± 0.95 MPa for sandblast with resin cement, 2.45 ± 1.15 MPa for 10-MDP with bioactive cement, and 1.68 ± 1.03 MPa for 10-MDP with resin cement. Significant improvements in bond strength were observed in the bioactive cement group treated with 10-MDP compared to those treated with sandblasting (p < 0.05). The 10-MDP treatment did not enhance bond strength for the resin cement compared to sandblasting. CONCLUSIONS: Bioactive cement generally provides a higher tensile bond strength than resin cement. While 10-MDP treatment enhances bond strength when used with bioactive cement, it does not show a similar enhancement when used with resin cement compared to sandblasting, indicating its effectiveness is selective based on the type of cement used.

Prediction of HPC compressive strength based on machine learning.

There is a complex high-dimensional nonlinear mapping relationship between the compressive strength of High-Performance Concrete (HPC) and its components, which has great influence on the accurate prediction of compressive strength. In this paper, an efficient robust software calculation strategy combining BP Neural Network (BPNN), Support Vector Machine (SVM) and Genetic Algorithm (GA) is proposed for the prediction of compressive strength of HPC. 8 features were extracted from the previous literature, and a compressive strength database containing 454 sets of data was constructed. The model was trained and tested, and the performance of 4 Machine Learning (ML) models, namely BPNN, SVM, GA-BPNN and GA-SVM, was compared. The results show that the coupled model is superior to the single model. Moreover, because GA-SVM has better generalization ability and theoretical basis, its convergence speed and prediction accuracy are better than GA-BPNN. Then Grey Relational Analysis (GRA) and Shapley analysis were used to verify the interpretability of the GA-SVM model, which showed that the water-binder ratio had the most significant influence on the compressive strength. Finally, the combination of multiple input variables to evaluate the compressive strength supplemented this research, and again verified the significant influence of water-binder ratio, providing reference value for subsequent research.

Effect of laser and coating surface treatment on the bond strength of zirconia ceramics.

OBJECTIVES: This study aims to investigate bond strength between zirconia and resin cement through surface treatments with Er: YAG laser, Nd: YAG laser, and Si-Zr coating. METHODS: Seventy-five round pre-sintered zirconia discs with a diameter of 18 mm and a thickness of 1.5 mm were prepared by a powder compactor. Fifty discs were randomly divided into five groups of 10 discs each and were subjected to five surface treatments: no treatment (control group), sandblasting with alumina particles (sandblasting group), Er: YAG laser treatment (Er: YAG laser group), Nd:YAG laser treatment (Nd: YAG laser group), and Si-Zr coating treatment (Si-Zr coating group). The discs were then bonded to composite resin columns with resin cement. The shear bond strength of each group was tested with a universal tester. Roughness tester, scanning electron microscope (SEM), and energy dispersive spectroscopy were used to analyze surface performance. RESULTS: The bond strength of the Si-Zr coating group was higher than that of the remaining groups (P<0.05). The difference in bond strength between the sandblasting group and the Er: YAG laser group was not statistically significant (P>0.05), but both of them had higher bond strength than the Nd: YAG laser group (P<0.05). The Si-Zr coating group had the highest surface roughness (P<0.05). The surface roughness of the sandblasting, Er: YAG laser, and Nd: YAG laser groups was higher than that of the control group (P<0.05), but the difference among the three groups was not statistically significant (P>0.05). SEM observations showed irregular scratches on the surface of the sandblasting group and large pits with holes on the surface of the Er: YAG and Nd: YAG laser groups. In the Er: YAG laser group, the crystal structure was replaced by a smooth surface with a large amount of microcracks due to partial melting. Complex porous structures that comprised "island-like" structures and mass pores among the grains were observed on the surface of the Si-Zr coating. Only Zr, O, and Y were detected on the surfaces of the control, Er: YAG laser, and Nd: YAG laser groups. Al was found on the surface of the sandblasted group, and a higher proportion of Si was detected on the surface of the Si-Zr coating group. CONCLUSIONS: Er: YAG laser and Nd: YAG laser treatment on the zirconia ceramic surface could increase roughness and improve the bond strength to resin cement. Si-Zr coating treatment is an effective alternative for increasing the roughness and bond strength of zirconia surface and is superior to sandblasting and laser treatments.

Association Between Handgrip Strength and Mortality of Patients With Coronary Artery Disease: A Meta-Analysis.

BACKGROUND: Muscular strength has been linked to increased risk of cardiovascular disease in the community population. The aim of this systematic review and meta-analysis is to evaluate the association between weak handgrip strength (HGS) and mortality risk in patients with coronary artery disease (CAD). METHODS: To carry out the meta-analysis, an extensive search was conducted on databases such as PubMed, Embase, Web of Science, Cochrane Library, Wanfang, and CNKI to identify observational studies with longitudinal follow-up. Random-effects models were used to combine the findings, taking into account the potential influence of heterogeneity. RESULTS: Eight observational studies involving 10 543 patients with CAD were included. During a mean follow-up duration of 20.4 months, 1327 (12.6%) patients died. Pooled results showed that weak HGS at baseline was associated with an increased risk of all-cause mortality during follow-up (risk ratio [RR]: 1.95, 95% confidence interval: 1.50 to 2.55, p < 0.001; I2 = 62%). Subgroup analysis suggested a stronger association between weak HGS and increased mortality in older patients with CAD as compared to that of overall adult patients with CAD (RR: 3.01 vs. 1.60, p for subgroup difference = 0.004). Subgroup analyses according to study location, design, subtype of CAD, follow-up duration, analytical model, and study quality scores showed similar results (p for subgroup difference all > 0.05). CONCLUSIONS: Weak HGS at baseline is associated with an increased risk of mortality in patients with CAD, particularly in older patients with CAD.

Macroscopic and microscopic analysis of the effects of moisture content and dry density on the strength of loess.

To clarify the impact of moisture content and dry density on the strength of loess, the remolded loess samples with different moisture content and dry density were prepared, and the influence of moisture content and dry density on loess strength was explored from the macro level by direct shear test without suction control. On this basis, the mechanism of the influence of moisture content and dry density on loess strength was explored from the micro level by nuclear magnetic resonance method. The research results indicate that: In the case of low water content, there are peak points in the stress-strain curve of remolded loess, exhibiting strain softening characteristics. In the case of high water content, there is no obvious peak in the stress-strain curve, exhibiting strain hardening characteristics. Moisture has a significant impact on the shear strength of remolded loess. As the moisture content of the soil sample increases, the cohesion decreases significantly, and the change in internal friction angle is not obvious. As the moisture content continues to increase, the free water content continues to increase. Free water will continuously soften the soil particle structure, reduce the bonding force between soil particles, and cause the cohesion to decrease with the increase of moisture content. The change in dry density also has a significant impact on the shear strength parameters of remolded loess. As the dry density of the soil sample increases, the cohesion increases. The smaller the dry density, the larger the pore ratio, and the looser the contact between soil particles, weakening the bonding effect. The larger the pore ratio, the more bound water is converted to free water, and the strong bonding force between the water film and soil particles disappears. Both of these microscopic factors can lead to a decrease in cohesion with a decrease in dry density.

Identifying Deficits in Hip and Knee Muscle Strength on the Surgical and Nonsurgical Sides in Women Up to 12 Months After Total Hip Arthroplasty.

OBJECTIVE: Regaining hip and knee muscle strength is important after total hip arthroplasty (THA). However, it is unclear if muscles other than those of the operated hip also lose strength. This study aimed to identify deficits in hip and knee strength on the surgical and nonsurgical sides in female patients up to 12 months after THA. METHODS: Participants were 91 female patients who had hip osteoarthritis and underwent unilateral THA. Forty-six community-dwelling women who were asymptomatic were selected as control participants. Patients with locomotor disorders or postsurgical complications were excluded. Maximal isometric strength of the hip flexors, extensors, and abductors, and knee extensors and flexors on the surgical and nonsurgical sides were measured before THA and 3, 6, and 12 months thereafter. RESULTS: Twelve months after THA, hip flexion, extension, and abduction strength on the surgical side were 84.6%, 83.5%, and 76.2%, respectively, of those in individuals who were asymptomatic; at the same time point, those on the nonsurgical side were 94.8%, 83.9%, and 79.4%, respectively. Knee extension strength on the surgical side was 89.3% of that in individuals who were asymptomatic. Compared to individuals who were asymptomatic, nearly all muscles showed significantly lower strength on both sides up to 6 months after THA. CONCLUSION: At 12 months after THA, hip and knee strength on both the surgical and nonsurgical sides did not recover to the level observed in individuals who were asymptomatic. In particular, hip abductor strength on the surgical and nonsurgical sides were 76% and 79%, respectively, of that in individuals who were asymptomatic. IMPACT STATEMENT: At 12 months after THA, hip and knee strength on the surgical and nonsurgical sides did not recover to the level observed in individuals who were asymptomatic, suggesting that the nonsurgical side may be inappropriate as a control to assess strength recovery on the surgical side.

Mechanical properties and crown accuracy of additively manufactured zirconia restorations.

OBJECTIVES: We evaluated the mechanical properties of zirconia restorations produced via additive manufacturing (AM) and the crown accuracy of zirconia crowns. METHODS: Zirconia disks, bars, and crowns were manufactured via subtractive (CNC group) and additive manufacturing (AM group) techniques. Disk-shaped specimens in each group were autoclaved at 134 °C and 216 kPa for 5, 10, and 24 h. The phases of the specimens were analyzed using an X-ray diffractometer. The flexural strengths were measured via biaxial flexural tests. The morphologies were examined using a scanning electron microscope. The correlation between the m-phase fraction and biaxial flexural strength by autoclave time in each group was analyzed via linear mixed model and Pearson's correlation analysis. For each group, crown specimens were used to assess the marginal and internal gaps using the replica technique. Buccolingual and mesiodistal cross-sections were measured, and a repeated measures one-way ANOVA was performed. RESULTS: Linear mixed model analysis indicated that for both groups, with an increase in the autoclave time, the flexural strength decreased, whereas the m-phase fraction increased. Pearson's correlation analysis revealed no correlation between the m-phase fraction and flexural strength for either group. A repeated measures one-way ANOVA was conducted on instrumented sections (buccal, lingual, mesial, and distal), revealing that the marginal and internal gaps of AM-produced zirconia crowns were less accurate than those of CNC-produced zirconia crowns. SIGNIFICANCE: These findings suggest that additively produced zirconia restorations have mechanical properties comparable to those of conventionally produced ceramics and may be suitable for clinical applications.

Associations of muscle mass and strength with depression among US adults: A cross-sectional NHANES study.

OBJECTIVES: The aim of our study was to assess the association between muscle mass and strength and depression through a cross-sectional study of the National Health and Nutrition Examination Survey from 2011 to 2014. METHODS: Muscle mass was calculated by summing the lean body mass of the limbs and muscle strength was assessed by grip strength. Depression was determined by The 9-item Patient Health Questionnaire. We used weighted multivariate logistic regression models to explore the relationship between muscle mass and strength and depression. Generalized additive models were used to test for the presence of nonlinear associations. We then constructed a two-piece-wise linear regression model and performed a recursive algorithm to calculate inflection points. In addition, subgroup analyses and interaction tests were performed. RESULTS: The study recruited 4871 adults from the United States. In regression models adjusted for all confounding variables, the OR (95 % CI) for the association between grip strength and appendicular lean mass (ALM) and depression were 0.943 (0.903, 0.985), 0.945 (0.908, 0.983), respectively. There was a non-linear association between grip strength and depression with a turning point of 46.3. The OR (95 % CI) before the turning point was 0.920 (0.872, 0.972). The interaction was statistically significant only in the age analysis. There was also a nonlinear association between ALM and depression, but no significant turning point was found. The interaction was statistically significant in the gender and BMI analyses. CONCLUSION: Grip strength and ALM are negatively associated with an increased likelihood of depression in US adults. Exercises for muscle mass and strength may help prevent depression.

Association of handgrip strength asymmetry and weakness with depression among middle-aged and older population in China: A cohort study.

BACKGROUND: Handgrip strength (HGS) weakness and asymmetry were recently reported to be associated with age-related health conditions. However, little is known about their combined effects on depression. We aimed to explore the joint association of HGS asymmetry and weakness with depressive symptoms in Chinese middle and older aged population. METHODS: 8700 participants aged ≥45 years were enrolled from China Health and Retirement Longitudinal Study (2015-2018). HGS weakness was determined as maximal HGS < 28 kg in males and <18 kg in females. HGS asymmetry was measured by HGS ratio and was defined using two different rules. Specifically, HGS ratio < 0.90 or >1.10 (10 % rule) and <0.80 or >1.20 (20 % rule) were considered as asymmetry. Participants were classified into four groups: normal and symmetric HGS, asymmetry only, weakness only, and both weakness and asymmetry. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale, with scores ≥12 defined as depression. The logistic regression and multiple linear regression models were conducted to estimate the associations between HGS status and depressive symptoms. RESULTS: The three-year incidence of depression was 19.2 %. After adjusting for covariates, compared to normal and symmetric HGS, participants with both HGS asymmetry and weakness showed the greatest risk of incident depression (10 % rule: OR 1.55, 95 % CI 1.19-2.02; 20 % rule: OR 1.71, 95 % CI 1.16-2.50). The coexistence of asymmetry and weakness was related to a significant increase in depression score (10 % rule: ß 0.96, 95 % CI 0.38-1.54; 20 % rule: ß 0.94, 95 % CI 0.08-1.81). The complete case analysis supported the results, and the associations were not modified by age, sex, and hand dominance. LIMITATIONS: Depressive assessment was based on self-reported screening instrument. CONCLUSIONS: The presence of both HGS asymmetry and weakness was associated with a higher risk of depression. Examining HGS asymmetry along with weakness may aid in identifying individuals at risk of depression to enable early interventions.