Innovation for Orthopaedic Surgeons.

Entrepreneurship and innovation are cornerstones of the economy and move healthcare forward. Most physicians have little experience or knowledge in developing and commercializing novel concepts and ideas. It is important to focus on structured thinking concepts, fundraising, intellectual property, FDA regulations, and initial incorporation and teambuilding strategies. There are various aspects of creating ideas and moving them from notes scribbled on a napkin to a product or service, which can then be integrated into the economic fabric of the healthcare system. Surgeon founders and innovators can then share key aspects any surgeon should consider when becoming an entrepreneur.

Perspectives and Recommendations Regarding Standards for Ultraviolet-C Whole-Room Disinfection in Healthcare.

Patient well-being must be the driving force for determining standards for disinfection systems based on ultraviolet-C (UV-C) radiation. Reductions of inoculated bacteria on carriers is the optimal method of validating a UV-C-emitting system. We make specific, evidence-based recommendations regarding room description, organism selection, carrier material, quantity, orientations, and locations. Criteria for a satisfactory performance are discussed. Adoption of these requirements will ensure that devices intended for room disinfection provide the greatest chances for prevention of environmentally derived healthcare-associated infections.

Suction-modified needle biopsy technique for the human soleus muscle.

INTRODUCTION: The needle biopsy technique for the soleus muscle is of particular interest because of the muscle's unique fiber type distribution, contractile properties, and sensitivity to unloading. Unlike other commonly biopsied muscles, the soleus is not fully superficial and is in close proximity to neurovascular structures, resulting in a more challenging biopsy. Because of this, a standardized protocol for performing needle biopsies on the human soleus muscle that is safe, reliable, and repeatable is presented. METHODS: Ultrasonography was used on an initial set of 12 subjects to determine the optimal biopsy zone, thereby guiding the location of the incision site. There were 45 subjects recruited who attended 2 separate biopsy sessions. Each biopsy session incorporated 3 passes of the biopsy needle proximal, posterior, and distal using suction from a portable vacuum source producing 3 separate muscle specimens. RESULTS: There were 84 soleus muscle biopsy procedures which were successfully conducted yielding 252 total samples without complication. Ultrasonography was used to confirm biopsy needle infiltration of the soleus muscle. Average sample weight obtained per pass was 61.5 +/- 15.7 mg. Histochemistry and molecular analyses demonstrated a considerably higher amount of slow type I MHC in comparison to the vastus lateralis, providing verification for the successful sampling of the soleus muscle. DISCUSSION: The procedure presented consists of a detailed protocol to accurately and consistently obtain muscle biopsy samples from the human soleus muscle. We have demonstrated that the human soleus biopsy is a safe, reliable, and repeatable procedure providing ample tissue for multiple types of analyses.

Would it be helpful to infection control professionals to have the FDA regulate whole-room UVC devices?

A 2-question survey was performed at the 2022 Annual Meeting of the Association of Professionals in Infection Control (APIC) regarding whole-room ultraviolet C (UVC) disinfection devices. Ninety-six questionnaires were completed. About 82.3% indicated FDA regulation of UVC devices would help them, 5.2% responded they would not, and 12.5% were neutral. About 84.4% ranked thoroughness of disinfection as the most important attribute of a whole-room UVC device. And 13.5% indicated ease of use and time required as most important.

Operating room disinfection: operator-driven ultraviolet 'C' vs. chemical treatment.

Background: In operating room (OR) surfaces, Nosocomial pathogens can persist on inanimate surfaces for long intervals and are highly resistant to traditional surface cleaning. Aim: This study compares traditional chemical operating room terminal disinfection to a unique operator-driven device that emits germicidal UV light at short distance onto vertical and horizontal surfaces. Methods: A randomized crossover analogous protocol assigned 40 end-of-day operating rooms into either group A (chemical then UVC treatments) or group B (UVC then chemical treatments). Initial Staphylococcal cultures were obtained prior to disinfection treatment, after the first treatment, and after the second treatment at 16 most commonly contaminated sites to represent overall room contamination. Success was defined as no growth and failure as 1 or more colony forming units. Thoroughness of chemical treatment vs UVC treatment was compared and used to determine if the second treatment was additive to the first treatment within each group. Findings: The operator driven UVC device outperformed chemical treatment in reducing the number of contaminated sites in the OR by more than half (P<0.001). Operator-driven UVC reduced contaminated sites after chemical treatment by nearly half (P<0.001). In contrast, chemical treatment after operator-driven UVC did not significantly reduce the number of contaminated sites. The mean employee time of disinfection for chemical treatment was 49 minutes and for the operator-driven UVC emitter 7.9 minutes (P<0.001). Conclusions: This study demonstrates that addition of an operator-driven UVC emitter to OR rooms between cases could be helpful in overall decreasing the number of contaminated sites.

Exercise Responses to Gravity-Independent Flywheel Aerobic and Resistance Training.

BACKGROUND: Although several exercise systems have been developed to mitigate the physiological deconditioning that occurs in microgravity, few have the capacity to positively impact multiple physiological systems and still meet the volume/mass requirements needed for missions beyond low Earth orbit. The purpose of this study was to test the gravity-independent Multi-Mode Exercise Device (M-MED) for both resistance (RE) and aerobic (AE) training stimuli. METHODS: Eight men and nine women (mean age 22.0 ± 0.4 yr) completed 5 wk of training on the M-MED: RE 4 × 7 squats 2 d/wk, and AE 4 × 4-min rowing bouts at ∼90% Vo2max 3 d/wk. Pre- and post-training data collection included an aerobic capacity test, MR imaging, strength testing, and vastus lateralis muscle biopsy. RESULTS: Vo2max increased 8%, 3RM strength 18%, and quadriceps femoris cross-sectional area (CSA) 10%. Knee extensor strength increased at all isokinetic speeds tested. Subjects also demonstrated improved fatigue resistance in knee extension. At the cellular and molecular level, the biopsy revealed increases in mixed myofiber CSA (13%), citrate synthase activity (26%), total RNA concentration (24%), IGF-I mRNA (77%), and Type IIa myosin heavy chain (MHC) mRNA (8%), and a concomitant decrease in Type IIx MHC mRNA (-23%). None of the changes were gender-specific. DISCUSSION: Both the functional outcomes and biomarker changes indicate that a very low volume of M-MED exercise results in robust adaptation in the cardiovascular and musculoskeletal systems. The M-MED has the potential to provide a wide range of countermeasure exercises and should be considered for testing in ground-based spaceflight simulation.

Concurrent exercise on a gravity-independent device during simulated microgravity.

PURPOSE: The objective of this study is to examine the effect of a high-intensity concurrent training program using a single gravity-independent device on maintaining skeletal muscle function and aerobic capacity during short-term unilateral lower limb suspension (ULLS). METHODS: Nineteen subjects (10 males and 9 females; 21.0 ± 2.5 yr, 65.4 ± 12.2 kg) were separated into two groups: 1) 10-d ULLS only (n = 9) and 2) 10-d ULLS plus aerobic and resistance training (ULLS + EX, n = 10). Exercise was performed on a single gravity-independent Multi-Mode Exercise Device (M-MED) with alternating days of high-intensity interval aerobic training and maximal exertion resistance training. RESULTS: Aerobic capacity increased by 7% in ULLS + EX (P < 0.05). Knee extensor and ankle plantar flexor three-repetition maximum increased in the ULLS + EX group (P < 0.05), but this change was only different from ULLS in the plantar flexors (P < 0.05). Peak torque levels decreased with ULLS but were increased for the knee extensors and attenuated for the ankle plantar flexors with ULLS + EX (P < 0.05). A shift toward type IIx myosin heavy-chain mRNA occurred with ULLS and was reversed with ULLS + EX in the vastus lateralis (P < 0.05) but not the soleus. Myostatin and atrogin increased with ULLS in both the vastus lateralis and soleus, but this change was mitigated with ULLS + EX only in the vastus lateralis (P = 0.0551 for myostatin, P < 0.05 for atrogin). Citrate synthase was decreased in the soleus during ULLS but was increased with ULLS + EX (P < 0.05). CONCLUSION: These results indicate that an M-MED class countermeasure device appears to be effective at mitigating the deconditioning effects of microgravity simulated during a modified ULLS protocol.

Hemodynamic and metabolic responses to hypergravity on a human-powered centrifuge.

INTRODUCTION: Microgravity causes the deconditioning of many physiological systems, and there is great interest in developing effective countermeasures. We recently developed a short-arm human-powered centrifuge, and the primary objective of this study was to assess the hemodynamic and metabolic responses to exercise under hypergravity conditions. METHODS: Phase I compared the hemodynamic and metabolic responses to 1 Gz (upright cycle ergometry) and 2 Gz conditions (Space Cycle) at the same work rate. Phase II contrasted the hemodynamic and metabolic responses at 2 and 3 Gz and at the same work rate. Phase III examined the BP and heart rate (HR) responses during passive and active centrifugation. Phase IV examined the relationship between work rate and oxygen uptake. RESULTS: In Phase I, the HR and BP responses were very similar between the two Gz conditions, with the exception that 2 Gz produced a lower diastolic BP in female subjects. In Phase II, both systolic and diastolic BPs were similar under the two different Gz conditions. However, there was a significant increase in HR at 3 Gz. In Phase III, the slope of the HR/Gz relationship was greater for passive conditions, suggesting that venous return is facilitated by the skeletal muscle pump. In Phase IV, it was found that there was a highly linear relationship between work rate and oxygen uptake. CONCLUSION: The results of this study demonstrate that exercise under low hypergravity conditions on the Space Cycle is well tolerated from a hemodynamic perspective.