Estimating Repetitions in Reserve During the Bench Press Exercise: Should We Consider Sex and the Exercise Equipment?

BACKGROUND: Estimating repetitions in reserve (RIR) has been established as a valid and practical method for monitoring set configuration concerning proximity to failure in resistance training. However, factors such as sex and exercise equipment could interfere with the estimation process. Therefore, this study aimed to determine the influence of sex (female vs male) and exercise equipment (free-weight vs Smith machine) on the RIR estimation at different relative loads during the bench press exercise. HYPOTHESIS: Men would be more accurate than women in the RIR estimation, and participants would better perceive their actual effort at the Smith machine compared with the free-weight bench press exercise. STUDY DESIGN: Repeated measures design. LEVEL OF EVIDENCE: Level 3. METHODS: In a counterbalanced order, recreationally trained participants (12 female, 14 male) performed 2 identical sessions with the free-weight bench press exercise in 1 week and 2 identical sessions with the Smith machine bench press exercise in another week (first session for familiarization and second session for validity analysis). In each session, participants performed single sets of repetitions to failure against 3 relative loads (65%, 75%, and 85% of the 1-repetition maximum [1RM]). RESULTS: Results revealed a significant interaction between RIR and sex at 65% 1RM (P < 0.01; women: -1.2 [-1.7 to -0.6] repetitions; men: -0.1 [-0.6 to 0.3] repetitions), and between RIR and exercise equipment at 65% 1RM (P < 0.01; free-weight: -1.1 [-1.5 to -0.6] repetitions; Smith machine: -0.2 [-0.6 to 0.2] repetitions), but not at 75% and 85% 1RM. CONCLUSIONS: RIR estimation is a valid method for monitoring set configuration. However, this method tends to underestimate RIR at 65%1RM with female athletes and in the free-weight exercise for both sexes. CLINICAL RELEVANCE: Strength and conditioning coaches should help their athletes understand effort awareness in the aforementioned context.

Effect of 5ß-dihydrotestosterone on vasodilator function and on cell proliferation.

Aging is one of the main factors associated with cardiovascular diseases. Androgens exert beneficial effects on the cardiovascular system and testosterone (TES) replacement therapy improves cardiometabolic risk factors. However, TES is contraindicated in patients with prostate cancer due to its proliferative effects on prostatic tumor cells. Additionally, TES and its reduced metabolites 5α- and 5ß-dihydrotestosterone (5α-DHT and 5ß-DHT) exert vasodilatory effects. Since androgen levels decrease during aging and 5ß-DHT lacks genomic effects, this study is focused on analyzing its effect on vasodilator function and the proliferation rate of prostatic tumor and vascular smooth muscle cells. To study the vascular function, mesenteric arteries from aged-orchidectomized Sprague-Dawley rats were used. Mesenteric segments were divided into one control (without treatment) and three groups with the androgens (10 nM, 30 min) to analyze: acetylcholine- and sodium nitroprusside-induced responses and nitric oxide and superoxide anion production. To analyze cell proliferation, the effect of androgens on cell viability was determined. The results showed that 5ß-DHT improves vasodilator function in arteries from aged-orchidectomized rats and induces antioxidant action, while the proliferation rate of the androgen-dependent prostatic tumor cells remains unaltered. These results make 5ß-DHT a promising therapeutic agent for the treatment of cardiovascular pathologies.

Ten Years Later: Still Unchanged Susceptibility to Antibiotics of Listeria monocytogenes from Poultry Processing Environments.

Listeria monocytogenes is still recognized as being commonly susceptible to antibiotics; however, there have been reports of reduced susceptibility in recent years. The significance of this resistance is not clear, in part due to the disparity in the antimicrobial susceptibility testing methods used. EUCAST (European Committee on Antimicrobial Susceptibility Testing) has recently proposed a standardized method for antibiotic susceptibility testing of L. monocytogenes. The aim of this work was to evaluate the susceptibility to 11 antibiotics in clinical use of 50 pulsed-field gel electrophoresis types of L. monocytogenes representing 347 isolates from a poultry industry setting using the EUCAST method and to compare the results with those obtained 10 years before. All poultry strains were sensitive to all the antibiotics tested but one strain was resistant to benzylpenicillin according to the EUCAST criteria. The current findings supported the previous study and confirmed that in certain food-associated L. monocytogenes populations, antibiotic sensitivity has remained stable.

Efficacy of Indigenous Bacteria in the Biodegradation of Hydrocarbons Isolated from Agricultural Soils in Huamachuco, Peru.

Pollution from crude oil and its derivatives poses a serious threat to human health and ecosystems, with accidental spills causing substantial damage. Biodegradation, using microorganisms to break down these contaminants, presents a promising and cost-effective solution. Exploring and utilizing new bacterial strains from underexplored habitats could improve remediation efforts at contaminated sites. This study aimed to evaluate the hydrocarbon biodegradation capacity of bacteria isolated from agricultural soils in Huamachuco, Peru. Soil samples from Oca crops were collected and bacteria were isolated. Biodegradation assays were conducted using diesel as the sole carbon source in the Bushnell Haas Mineral medium. Molecular characterization of the 16S rRNA gene identified four strains. Diesel biodegradation assays at 1% concentration were performed under agitation conditions at 150 rpm and 30 °C, and monitored on day 10 by measuring cellular biomass (OD600), with hydrocarbons analyzed by gas chromatography. The results showed Pseudomonas protegens (PROM2) achieved the highest efficiency in removing total hydrocarbons (91.5 ± 0.7%). Additionally, Pseudomonas citri PROM3 and Acinetobacter guillouiae ClyRoM5 also demonstrated high capacity in removing several individual hydrocarbons. Indigenous bacteria from uncontaminated agricultural soils present a high potential for hydrocarbon bioremediation, offering an ecological and effective solution for soil decontamination.

Simulation vs RISE UP: A Comparative Study of Approaches for Teaching Emergency Medicine Trainees How to Manage Microaggressions.

PURPOSE: Microaggressions are discriminatory actions or words targeted at people for their perceived or expressed identities. The study aimed to address the critical need for training emergency medicine (EM) resident-physicians to manage microaggressions. The authors compared the effectiveness of the Realizing Inclusion and Systemic Equity in Medicine: Upstanding in the Medical Workplace (RISE UP) curriculum from Inova Children's Hospital and a simulation (SIM) curriculum created by a research team specifically for this study. The new SIM curriculum was guided by the original RISE UP curriculum but incorporates simulation as a learning tool. These 2 educational modalities were selected based upon previous literature showing their efficacy as tools in medical education. METHOD: Through a collaboration with residency leadership, EM residents were recruited to participate in a comparison study in which they received either the RISE UP or newly created SIM curriculum as part of their regular simulation training. Pre- and post-intervention surveys assessed perceived knowledge on handling microaggressions. A follow-up survey was sent one month post-intervention to evaluate retention of self-reported knowledge. RESULTS: Out of 81 eligible residents, 69 residents participated: 37 in the new SIM curriculum group, 32 in the RISE UP curriculum group. Participants in both groups self-reported significant improvements in perceived knowledge immediately post-intervention. At the 1-month follow up, both intervention groups retained higher levels of perceived knowledge. Additionally, while both curricula were effective, the RISE UP group showed slightly higher retention rates of self-reported knowledge compared to the SIM group, although this difference was not statistically significant. CONCLUSIONS: Both the SIM and RISE UP curricula were effective in improving resident knowledge about handling workplace microaggressions, with participants in the RISE UP curriculum showing marginally better retention of skills. Implementing such educational programs may enhance workplace awareness and response to microaggressions among EM residents.

Robotic and Laparoscopic Adrenalectomy for Pheochromocytoma: An International Multicenter Study.

BACKGROUND AND OBJECTIVE: Robotic adrenalectomy (RA) has attracted interest as an alternative to laparoscopic adrenalectomy (LA) for patients with pheochromocytoma, although its beneficial effects are uncertain. Our aim was to compare RA and LA outcomes for these patients. METHODS: Data for patients who underwent RA or LA for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed. We analyzed baseline characteristics and postoperative complications at discharge, 90 d, and 1 yr. We conducted propensity score matching (PSM; 1:1 ratio) and multivariable analyses to evaluate outcomes and risk factors for the occurrence of complications and higher Comprehensive Complication Index (CCI). KEY FINDINGS AND LIMITATIONS: Of 1755 patients, 1613 (91.9%) underwent LA and 142 (8.1%) underwent RA. Estimated blood loss, conversion rate, complication rate, and CCI at discharge, 90 d, and 1 yr were similar between the groups. However, RA was associated with a longer operative time in comparison to LA (100 vs 123 min; p < 0.001), but not after PSM (p = 0.120). Multivariable analysis revealed that Charlson comorbidity index (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.07-1.29; p = 0.001), and tumor size per 1-cm increment (OR 1.13, 95% CI 1.07-1.21; p < 0.001) were independently associated with the incidence of complications, but there was no significant difference in complication rates between the LA and RA groups (OR 1.09, 95% CI 0.63-1.87; p = 0.767). After PSM, RA was associated with a lower rate of severe (grade ≥3a) complications in comparison to LA (p = 0.023). CONCLUSIONS AND CLINICAL IMPLICATIONS: RA is a safe alternative to LA and yields similar outcomes for patients with pheochromocytoma. RA may be associated with a lower likelihood of severe complications. Further studies are warranted to determine the role of robotic surgery in pheochromocytoma. PATIENT SUMMARY: Pheochromocytoma is a rare tumor in the adrenal gland and the gold-standard treatment is surgical removal. We assessed patient outcomes after robot-assisted surgery compared with laparoscopic surgery and found that outcomes are similar, but the rate of severe complications may be lower if a surgical robot is used.

The role of subjective risk perception and self-esteem in the relationship between sensation seeking and aberrant behaviors on the road: A moderated-moderation model.

INTRODUCTION: Road crashes are still one of the main causes of death around the world. Risky behavior has been proposed as one of the foremost predictors, with the theoretical framework of aberrant behavior emerging as a predominant approach for its examination. Sensation seeking has been pointed out as one of the main personality predictors of aberrant behavior. The current research aimed to investigate the moderated-moderation effect of both risk perception and self-esteem in the relationship between sensation seeking and aberrant behavior. METHOD: Two studies were conducted. The first study aimed to analyze the psychometric properties of the Spanish version of the Risk Perception Scale (RPS), a 10-item self-report to assess risk perception. A sample composed of 471 Spanish drivers (319 female, Mage = 29.75) completed the RPS. In the second study, a different sample of 236 Spanish drivers (129 female, Mage = 38.49) completed a set of self-reports aiming both to analyze the concurrent and divergent validity of the RPS, and to test the main moderated-moderation hypothesis. RESULTS: With respect to the first study, the confirmatory factor analysis (CFA) supported a 7-item version which fitted in a single reliable factor (α = .74). Regarding the second study, the results supported both the concurrent and divergent validity of the RPS. Likewise, it was verified the moderated-moderation effect in the case of ordinary violations (R2 = .34), aggressive violations (R2 = .20), and lapses (R2 = .12). CONCLUSIONS: The RPS is a useful self-report to assess subjective risk perception in Spanish drivers. Both self-esteem and risk perception affect the relationship between sensation seeking and aberrant driving behavior. PRACTICAL IMPLICATIONS: Intervention programs aiming to reduce aberrant driving behavior should be focused on reducing sensation seeking tendencies while simultaneously enhancing both risk perception skills and self-esteem.

Which drivers drive as they live and who are transformed while driving? Analysis of moderators in the relationship between general anger and driving anger.

INTRODUCTION: Trait driving anger is a widely studied personality variable in the field of road safety, due to its strong relationship with both risky behavior on the road and crash-related events. The Deffenbacher's Driving Anger Scale theoretical approach has underlined different situations that could provoke anger in drivers, although trait driving anger is usually analyzed as a whole. Trait general anger has been proposed as one of the most relevant predictors of trait driving anger, showing moderate relationships with it. METHOD: The current research aimed to analyze the relationship between trait general anger and each one of the situations provoking anger, as well as to search for personality variables that could moderate these relationships. Based on literature review, it was expected that self-esteem would moderate both Discourtesy and Hostile gestures, Type-A behavior pattern would moderate both Slow driving and Traffic obstructions, and conscientiousness would moderate both Police presence and Illegal driving. A sample of 417 drivers (Mage = 31.24, SDage = 13.59, 64.5% females) taken from the Spanish general population completed a set of self-reports. RESULTS: The results showed significant moderation effects in the case of Hostile gestures, Discourtesy, Illegal driving, and Slow driving. Conditional processes of these moderations were analyzed. Lastly, practical implications are discussed, allowing for tailored interventions to be implemented based on individual drivers' tendencies. Therefore, interventions should address different triggers of driving anger: boosting self-esteem for those angered by disrespect, targeting Type-A behavior reduction for those angered by traffic slowdowns, and promoting conscientiousness enhancement for those angered by others' risky driving.

Perspectives and pitfalls in preserving subterranean biodiversity through protected areas.

Subterranean ecosystems (comprising terrestrial, semi-aquatic, and aquatic components) are increasingly threatened by human activities; however, the current network of surface-protected areas is inadequate to safeguard subterranean biodiversity. Establishing protected areas for subterranean ecosystems is challenging. First, there are technical obstacles in mapping three-dimensional ecosystems with uncertain boundaries. Second, the rarity and endemism of subterranean organisms, combined with a scarcity of taxonomists, delays the accumulation of essential biodiversity knowledge. Third, establishing agreements to preserve subterranean ecosystems requires collaboration among multiple actors with often competing interests. This perspective addresses the challenges of preserving subterranean biodiversity through protected areas. Even in the face of uncertainties, we suggest it is both timely and critical to assess general criteria for subterranean biodiversity protection and implement them based on precautionary principles. To this end, we examine the current status of European protected areas and discuss solutions to improve their coverage of subterranean ecosystems.

Optimizing resistance training intensity in supportive care for survivors of breast cancer: velocity-based approach in the row exercise.

PURPOSE: Resistance training mitigates side effects during and after cancer treatment. To provide a new approach for precisely and safely assessing and prescribing the intensity of resistance training in supportive cancer care, the purpose of this study was to evaluate the load-velocity relationship during the row exercise in women survivors of breast cancer. METHODS: Twenty women survivors of breast cancer who had undergone surgery and had completed core breast cancer treatment within the previous 10 years completed an incremental loading test until the one repetition maximum (1RM) in the row exercise. The velocity was measured during the concentric phase of each repetition with a linear velocity transducer, and their relationship with the relative load was analyzed by linear and polynomial regression models. RESULTS: A strong relationship was observed between movement velocity and relative load for all measured velocity variables using linear and polynomial regression models (R2 > 0.90; SEE < 6.00%1RM). The mean velocity and mean propulsive velocity of 1RM was 0.40 ± 0.03 m·s-1, whereas the peak velocity at 1RM was 0.64 ± 0.07 m·s1. CONCLUSION: In women survivors of breast cancer, monitoring movement velocity during the row exercise can facilitate precise assessment and prescription of resistance training intensity in supportive cancer care.

Management of cytomegalovirus in adult solid organ transplant patients: GESITRA-IC-SEIMC, CIBERINFEC, and SET recommendations update.

Cytomegalovirus (CMV) infection remains a significant challenge in solid organ transplantation (SOT). The last international consensus guidelines on the management of CMV in SOT were published in 2018, highlighting the need for revision to incorporate recent advances, notably in cell-mediated immunity monitoring, which could alter the current standard of care. A working group including members from the Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Transplantation (SET), developed consensus-based recommendations for managing CMV infection in SOT recipients. Recommendations were classified based on evidence strength and quality using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The final recommendations were endorsed through a consensus meeting and approved by the expert panel.

CO2 Adsorption by CMK-3 at Low Temperatures and High Pressure to Reduce the Greenhouse Effect.

In this study, the maximum CO2 capture capacity of an ordered mesoporous carbon (CMK-3) was evaluated at high pressure (35 atm) and several temperatures (0, 10, 20, and 35 °C). CMK-3 was synthesized with the hard template method (silica SBA-15) using furfuryl alcohol and toluene as carbon sources. The CO2 adsorption isotherms were fitted to the following adsorption theories: Freundlich, Langmuir, Sips, Toth, Dubinin-Radushkevich, and Temkin. The maximum capture capacity (726.7 mg·g-1) was achieved at 0 °C and 34 atm. The results of the study of successive adsorption-desorption cycles showed that multi-cycle reversible gas capture processes could be used in optimal temperature and pressure conditions. It was determined that 0.478 g of CMK-3 would be required to reduce the CO2 concentration in 1 m3 of air to pre-industrial levels (280 ppm). The obtained results may contribute to technological developments for the mitigation of human impacts on the environment through the capture of atmospheric CO2.

A Multi-Target Pharmacological Correction of a Lipoyltransferase LIPT1 Gene Mutation in Patient-Derived Cellular Models.

Mutations in the lipoyltransferase 1 (LIPT1) gene are rare inborn errors of metabolism leading to a fatal condition characterized by lipoylation defects of the 2-ketoacid dehydrogenase complexes causing early-onset seizures, psychomotor retardation, abnormal muscle tone, severe lactic acidosis, and increased urine lactate, ketoglutarate, and 2-oxoacid levels. In this article, we characterized the disease pathophysiology using fibroblasts and induced neurons derived from a patient bearing a compound heterozygous mutation in LIPT1. A Western blot analysis revealed a reduced expression of LIPT1 and absent expression of lipoylated pyruvate dehydrogenase E2 (PDH E2) and alpha-ketoglutarate dehydrogenase E2 (α-KGDH E2) subunits. Accordingly, activities of PDH and α-KGDH were markedly reduced, associated with cell bioenergetics failure, iron accumulation, and lipid peroxidation. In addition, using a pharmacological screening, we identified a cocktail of antioxidants and mitochondrial boosting agents consisting of pantothenate, nicotinamide, vitamin E, thiamine, biotin, and α-lipoic acid, which is capable of rescuing LIPT1 pathophysiology, increasing the LIPT1 expression and lipoylation of mitochondrial proteins, improving cell bioenergetics, and eliminating iron overload and lipid peroxidation. Furthermore, our data suggest that the beneficial effect of the treatment is mainly mediated by SIRT3 activation. In conclusion, we have identified a promising therapeutic approach for correcting LIPT1 mutations.

Evaluating the factor structure and measurement invariance of the 20-item short version of the UPPS-P Impulsive Behavior Scale across multiple countries, languages, and gender identities.

The UPPS-P Impulsive Behavior Model and the various psychometric instruments developed and validated based on this model are well established in clinical and research settings. However, evidence regarding the psychometric validity, reliability, and equivalence across multiple countries of residence, languages, or gender identities, including gender-diverse individuals, is lacking to date. Using data from the International Sex Survey (N = 82,243), confirmatory factor analyses and measurement invariance analyses were performed on the preestablished five-factor structure of the 20-item short version of the UPPS-P Impulsive Behavior Scale to examine whether (a) psychometric validity and reliability and (b) psychometric equivalence hold across 34 country-of-residence-related, 22 language-related, and three gender-identity-related groups. The results of the present study extend the latter psychometric instrument's well-established relevance to 26 countries, 13 languages, and three gender identities. Most notably, psychometric validity and reliability were evidenced across nine novel translations included in the present study (i.e., Croatian, English, German, Hebrew, Korean, Macedonian, Polish, Portuguese-Portugal, and Spanish-Latin American) and psychometric equivalence was evidenced across all three gender identities included in the present study (i.e., women, men, and gender-diverse individuals).

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.

Sex and Equipment Impact on Lifting Velocity and the Maximum Repetitions in Bench Press.

This study investigated how equipment and sex affect the prediction accuracy of the maximum number of repetitions performed to failure (RTF) using the fastest mean velocity of the set (MVfastest). Sixteen men and twelve women completed four sessions (two using free-weight equipment and two sessions using the Smith machine). Each session involved three sets of repetitions to failure against the 65%, 75%, and 85% of the one-repetition maximum, interspersed by 10-min of rest. The goodness-of-fit of the individualized RTF-MVfastest relationships was comparable between both equipment types and sexes (P≥0.510). Moreover, there were not significant differences in the MVfastest associated with RTF between equipment types (P≥0.258). However, the MVfastest associated with RTF was higher for men than for women in repetitions 6 to 15 (P≤0.043; ES≥0.69). In addition, the absolute errors when predicting RTF showed no significant differences between equipment types and loads (P<0.444). Specifically, these RTF estimates were within an acceptable range for men (<2 repetitions), but not for women (≥2 repetitions) (main effect of sex: P≤0.018; ES≥0.58). These findings suggest that individualized RTF-MVfastest equations estimate the RTF with an acceptable precision in men during bench press exercises in both equipment types but exhibit lower precision for women.

Why Do People Watch Pornography? Cross-Cultural Validation of the Pornography Use Motivations Scale (PUMS) and Its Short Form (PUMS-8).

Motivations for pornography use may vary across gender identities, sexual orientations, and geographical regions, warranting examination to promote individual and public health. The aims of this study were to validate the Pornography Use Motivations Scale (PUMS) in a diverse, multicultural sample, and develop a short form (PUMS-8) that can assess a wide range of pornography use motivations. Using data from 42 countries (N = 75,117; Mage = 32.07; SDage = 12.37), enabled us to thoroughly evaluate the dimensionality, validity, and reliability of the Pornography Use Motivations Scale (PUMS), leading to the development of the more concise PUMS-8 short scale. Additionally, language-, nationality-, gender-, and sexual-orientation-based measurement invariance tests were conducted to test the comparability across groups. Both the PUMS and the PUMS-8 assess eight pornography use motivations, and both demonstrated excellent psychometric properties. Sexual Pleasure emerged as the most frequent motivation for pornography use across countries, genders, and sexual orientations, while differences were observed concerning other motivations (e.g. self-exploration was more prevalent among gender-diverse individuals than men or women). The motivational background of pornography use showed high similarity in the examined countries. Both the PUMS and the PUMS-8 are reliable and valid measurement tools to assess different types of motivations for pornography use across countries, genders, and sexual orientations. Both scales are recommended for use in research and clinical settings.

Analysis of the Initial Learning Curve for Robotic-Assisted Total Knee Arthroplasty Using the ROSA® Knee System.

Background/Objectives: Total knee arthroplasty (TKA) is a frequent procedure in orthopedic surgery. Advances in TKA include the development of robotic-assisted systems. Training in raTKA entails a learning curve to achieve proficiency comparable to conventional manual TKA (maTKA). Methods: We conducted a prospective study of the learning curve in raTKA using the Robotic Surgical Assistant (ROSA) Knee System. The study included 180 patients (90 raTKAs; 90 maTKAs) and three surgeons (one with >15 years of experience in maTKA). The cumulative sum control chart method (CUSUM) was used to define the transition from the learning phase to the mastered phase in raTKA. Results: The learning curves were 43 cases (experienced surgeons) and 61 cases (all surgeons). Mean operative times for both phases in raTKA were longer than in maTKA (p < 0.001). In raTKA, operative times in the learning phase were longer compared to those in the mastered phase (p < 0.001). Operative times in the learning and mastered phases for all surgeons in raTKA were significantly longer compared to those in maTKA (p < 0.001); however, operative times of the experienced surgeon in the mastered phase of raTKA and in maTKA showed no differences. Conclusions: The learning curve in raTKA is dependent upon the surgeon's previous experience in maTKA.