Comparison of Fusion Rates among Various Demineralized Bone Matrices in Posterior Lumbar Interbody Fusion.

Background and Objectives: Posterior lumbar interbody fusion (PLIF) plays a crucial role in addressing various spinal disorders. The success of PLIF is contingent upon achieving bone fusion, as failure can lead to adverse clinical outcomes. Demineralized bone matrix (DBM) has emerged as a promising solution for promoting fusion due to its unique combination of osteoinductive and osteoconductive properties. This study aims to compare the effectiveness of three distinct DBMs (Exfuse®, Bongener®, and Bonfuse®) in achieving fusion rates in PLIF surgery. Materials and Methods: A retrospective review was conducted on 236 consecutive patients undergoing PLIF between September 2016 and February 2019. Patients over 50 years old with degenerative lumbar disease, receiving DBM, and following up for more than 12 months after surgery were included. Fusion was evaluated using the Bridwell grading system. Bridwell grades 1 and 2 were defined as 'fusion', while grades 3 and 4 were considered 'non-fusion.' Clinical outcomes were assessed using visual analog scale (VAS) scores for pain, the Oswestry disability index (ODI), and the European quality of life-5 (EQ-5D). Results: Fusion rates were 88.3% for Exfuse, 94.3% for Bongener, and 87.7% for Bonfuse, with no significant differences. All groups exhibited significant improvement in clinical outcomes at 12 months after surgery, but no significant differences were observed among the three groups. Conclusions: There were no significant differences in fusion rates and clinical outcomes among Exfuse, Bongener, and Bonfuse in PLIF surgery.

Integrated genomic analyses of cutaneous T-cell lymphomas reveal the molecular bases for disease heterogeneity.

Cutaneous T-cell lymphomas (CTCLs) are a clinically heterogeneous collection of lymphomas of the skin-homing T cell. To identify molecular drivers of disease phenotypes, we assembled representative samples of CTCLs from patients with diverse disease subtypes and stages. Via DNA/RNA-sequencing, immunophenotyping, and ex vivo functional assays, we identified the landscape of putative driver genes, elucidated genetic relationships between CTCLs across disease stages, and inferred molecular subtypes in patients with stage-matched leukemic disease. Collectively, our analysis identified 86 putative driver genes, including 19 genes not previously implicated in this disease. Two mutations have never been described in any cancer. Functionally, multiple mutations augment T-cell receptor-dependent proliferation, highlighting the importance of this pathway in lymphomagenesis. To identify putative genetic causes of disease heterogeneity, we examined the distribution of driver genes across clinical cohorts. There are broad similarities across disease stages. Many driver genes are shared by mycosis fungoides (MF) and Sezary syndrome (SS). However, there are significantly more structural variants in leukemic disease, leading to highly recurrent deletions of putative tumor suppressors that are uncommon in early-stage skin-centered MF. For example, TP53 is deleted in 7% and 87% of MF and SS, respectively. In both human and mouse samples, PD1 mutations drive aggressive behavior. PD1 wild-type lymphomas show features of T-cell exhaustion. PD1 deletions are sufficient to reverse the exhaustion phenotype, promote a FOXM1-driven transcriptional signature, and predict significantly worse survival. Collectively, our findings clarify CTCL genetics and provide novel insights into pathways that drive diverse disease phenotypes.

Gender difference in bowing of the sagittal femoral morphology measurement using magnetic resonance imaging.

The importance of femoral sagittal bowing on total knee arthroplasty (TKA) has not been actively discussed. Femoral sagittal bowing can lead to cortex damage, fractures, or femoral malalignment. Therefore, the purpose of this study was to evaluate femoral sagittal bowing at different segments of the femur in the Korean population, and to discuss the implications on total knee arthroplasty. Differences in the morphology of femoral sagittal bowing for 978 patients-829 women and 148 men-were evaluated using magnetic resonance imaging. The angle between the femoral mechanical axis and the anterior cortex line was measured for all the patients. In addition, the gender difference in femoral sagittal bowing was investigated. The angle of femoral sagittal bowing with the mechanical axis was 2.8˚ ± 2.2˚. The angles for femoral sagittal bowing were 2.9˚ ± 2.2˚ and 2.3˚ ± 2.6˚ for females and males, respectively. Thus, a gender difference was found in the femoral sagittal bowing (p < 0.05). Excessive sagittal bowing of the femur can affect the final sagittal position of the femoral component, and this has implications for implant design selection. We recommend that surgeons accurately perform pre-operative evaluation of femoral bowing to prevent potential malalignment, rotation, and abnormal stresses between the femur and implant.

Genomic analysis of 220 CTCLs identifies a novel recurrent gain-of-function alteration in RLTPR (p.Q575E).

Cutaneous T-cell lymphoma (CTCL) is an incurable non-Hodgkin lymphoma of the skin-homing T cell. In early-stage disease, lesions are limited to the skin, but in later-stage disease, the tumor cells can escape into the blood, the lymph nodes, and at times the visceral organs. To clarify the genomic basis of CTCL, we performed genomic analysis of 220 CTCLs. Our analyses identify 55 putative driver genes, including 17 genes not previously implicated in CTCL. These novel mutations are predicted to affect chromatin (BCOR, KDM6A, SMARCB1, TRRAP), immune surveillance (CD58, RFXAP), MAPK signaling (MAP2K1, NF1), NF-κB signaling (PRKCB, CSNK1A1), PI-3-kinase signaling (PIK3R1, VAV1), RHOA/cytoskeleton remodeling (ARHGEF3), RNA splicing (U2AF1), T-cell receptor signaling (PTPRN2, RLTPR), and T-cell differentiation (RARA). Our analyses identify recurrent mutations in 4 genes not previously identified in cancer. These include CK1α (encoded by CSNK1A1) (p.S27F; p.S27C), PTPRN2 (p.G526E), RARA (p.G303S), and RLTPR (p.Q575E). Last, we functionally validate CSNK1A1 and RLTPR as putative oncogenes. RLTPR encodes a recently described scaffolding protein in the T-cell receptor signaling pathway. We show that RLTPR (p.Q575E) increases binding of RLTPR to downstream components of the NF-κB signaling pathway, selectively upregulates the NF-κB pathway in activated T cells, and ultimately augments T-cell-receptor-dependent production of interleukin 2 by 34-fold. Collectively, our analysis provides novel insights into CTCL pathogenesis and elucidates the landscape of potentially targetable gene mutations.

Effects of alternating exposure to cold and heat for 14 days on cold tolerance in winter.

People are exposed to heat regularly due to their jobs or daily habits in cold winter, but few studies have reported whether parallel heat and cold exposure and diminish cold acclimation. This study was conducted to investigate the effects of alternating exposure to cold and heat on cold tolerance in eight young males. A daily acclimation program to cold and heat, which consisted of 2-h sitting at 10 °C air in the morning and 2-h running and rest at 30 °C air in the afternoon, was conducted for 14 consecutive days. Eight male subjects participated in a cold tolerance test (10 °C [ ±â€¯0.3], 40%RH[ ±â€¯3]) before (PRE) and after (POST) completing the alternating exposure program. During the cold tolerance test, subjects remained sitting upright on a chair for 60 min. Rectal temperature (Tre) was lower in POST than in PRE during the 60-min cold tolerance test (P = 0.027). During the cold tolerance test, systolic, diastolic, and mean arterial blood pressures in POST were lower than those in PRE (P = 0.006, P = 0.005, and P = 0.004). No significant differences in skin temperatures between PRE and POST were found for the cold tolerance test. There were no significant differences in energy expenditure during cold exposure between PRE and POST. Subjects felt less cold in POST than in PRE (P = 0.013) whereas there was no significant difference in overall thermal comfort between PRE and POST. These results suggest that cold adaptation can still occur in the presence of heat stress.

Whole-body cold tolerance in older Korean female divers "haenyeo" during cold air exposure: effects of repetitive cold exposure and aging.

This study was conducted to investigate the effects of chronic and repetitive diving in cold sea water on physiological responses to cold in older Korean female divers, Haenyeo, who have been exposed to cold water through breath-hold diving since their teens. Young and older females, who have no experience of swimming in cold sea water, were recruited as control groups: older haenyeos (N = 10, 70 ± 3 years of age), young non-diving females (N = 10, 23 ± 2 years), and older non-diving females (N = 6, 73 ± 4 years). For the test of cold exposure, all subjects were exposed to cold in an air temperature of 12 °C with 45% RH in a sitting position for 60 min. The changes in core temperature showed no significant differences between older haenyeos and the other two groups. The decreases in mean skin temperature were greater for older haenyeos than the other two groups (P < 0.01). Older haenyeos had significantly lower energy expenditure during cold exposure when compared to older non-diving females (P < 0.05). Heart rate was significantly lower in older haenyeos than that of young non-diving females (P < 0.05). Older haenyeos felt cooler at the face with lower face temperature when compared with older non-diving females. The results indicate that older haenyeos respond to cold through reducing heat loss from the skin rather than increasing metabolic rate. These responses are distinctive features from the cold defensive system of young or older non-diving females.

Effect of Practice on Performance and Pacing Strategies During an Exercise Circuit Involving Load Carriage.

Burdon, CA, Park, J, Tagami, K, Groeller, H, and Sampson, JA. Effect of practice on performance and pacing strategies during an exercise circuit involving load carriage. J Strength Cond Res 32(3): 700-707, 2018-Pacing is critical for athletic endeavors, and the strategies used by athletes are often modified after practice. The importance of practice when completing occupational assessments has been established; however, the effect of load carriage and discrete subtask activities on strategies to modulate physical exertion to complete a work task simulation is currently unknown. Therefore, we sought to investigate the effect of practice on pacing strategies used to complete a physiological aptitude assessment circuit. Twenty-five participants completed an assessment designed for firefighters on 3 occasions. The circuit comprised 6 disparate tasks (including unilateral load carriage, static holds and fire-hose drags) with lap and task completion times recorded. Pacing strategies were examined relative to the effect of practice throughout (globally) and within the assessment (discrete tasks). By the second visit, overall test performance and discrete task performance of the first, fourth, and fifth tasks improved, respectively, by 12.6% (95% confidence interval: ±3.6%, p < 0.01), 12.4% (±6.0%, p < 0.01), 11.7% (±4.9%, p < 0.01), and 17.8% (±10.0%, p < 0.03). Compared with visit 1, significant improvements in performance were observed on the second and third visit. However, no significant additional improvement was noted between visits 2 and 3. Therefore, to reliably assess performance of the occupational test, 1 practice session (2 visits) is required. Practice is important to allow individuals to optimize their pacing strategy for successful performance.

A coding variant in FTO confers susceptibility to thiopurine-induced leukopenia in East Asian patients with IBD.

OBJECTIVE: Myelosuppression is a life-threatening complication of thiopurine therapy, and the incidence of thiopurine-induced myelosuppression is higher in East Asians than in Europeans. We investigated genetic factors associated with thiopurine-induced leukopenia in patients with IBD. DESIGN: A genome-wide association study (GWAS) was conducted in thiopurine-treated patients with IBD, followed by high-throughput sequencing of genes identified as significant in the GWAS or those involved in thiopurine metabolism (n=331). Significant loci associated with thiopurine-induced leukopenia were validated in two additional replication cohorts (n=437 and n=330). Functional consequences of FTO (fat mass and obesity-associated) variant were examined both in vitro and in vivo. RESULTS: The GWAS identified two loci associated with thiopurine-induced leukopenia (rs16957920, FTO intron; rs2834826, RUNX1 intergenic). High-throughput targeted sequencing indicated that an FTO coding variant (rs79206939, p.A134T) linked to rs16957920 is associated with thiopurine-induced leukopenia. This result was further validated in two replication cohorts (combined p=1.3×10-8, OR=4.3). The frequency of FTO p.A134T is 5.1% in Koreans but less than 0.1% in Western populations. The p.A134T variation reduced FTO activity by 65% in the nucleotide demethylase assay. In vivo experiments revealed that Fto-/- and Fto+/- mice were more susceptible to thiopurine-induced myelosuppression than wild-type mice. CONCLUSIONS: The results suggest that the hypomorphic FTO p.A134T variant is associated with thiopurine-induced leukopenia. These results shed light on the novel physiological role of FTO and provide a potential pharmacogenetic biomarker for thiopurine therapy.

Variations in body morphology explain sex differences in thermoeffector function during compensable heat stress.

NEW FINDINGS: What is the central question of this study? Can sex-related differences in cutaneous vascular and sudomotor responses be explained primarily by variations in the ratio between body surface area and mass during compensable exercise that elicits equivalent heat-loss requirements and mean body temperature changes across participants? What is the main finding and its importance? Mass-specific surface area was a significant determinant of vasomotor and sudomotor responses in men and women, explaining 10-48% of the individual thermoeffector variance. Nonetheless, after accounting for changes in mean body temperature and morphological differences, sex explained only 5% of that inter-individual variability. It was concluded that sex differences in thermoeffector function are morphologically dependent, but not sex dependent. Sex is sometimes thought to be an independent modulator of cutaneous vasomotor and sudomotor function during heat exposure. Nevertheless, it was hypothesized that, when assessed during compensable exercise that evoked equal heat-loss requirements across participants, sex differences in those thermoeffectors would be explained by variations in the ratio between body surface area and mass (specific surface area). To evaluate that possibility, vasomotor and sudomotor functions were assessed in 60 individuals (36 men and 24 women) with widely varying (overlapping) specific surface areas (range, 232.3-292.7 and 241.2-303.1 cm2  kg-1 , respectively). Subjects completed two trials in compensable conditions (28°C, 36% relative humidity) involving rest (20 min) and steady-state cycling (45 min) at fixed, area-specific metabolic heat-production rates (light, ∼135 W m-2 ; moderate, ∼200 W m-2 ). Equivalent heat-loss requirements and mean body temperature changes were evoked across participants. Forearm blood flow and vascular conductance were positively related to specific surface area during light work in men (r = 0.67 and r = 0.66, respectively; both P < 0.05) and during both exercise intensities in women (light, r = 0.57 and r = 0.69; and moderate, r = 0.64 and r = 0.68; all P < 0.05). Whole-body and local sweat rates were negatively related to that ratio (correlation coefficient range, -0.33 to -0.62; all P < 0.05) during both work rates in men and women. Those relationships accounted for 10-48% of inter-individual thermoeffector variance (P < 0.05). Furthermore, after accounting for morphological differences, sex explained no more than 5% of that variability (P < 0.05). It was concluded that, when assessed during compensable exercise, sex differences in thermoeffector function were largely determined morphologically, rather than being sex dependent.

Finger cold-induced vasodilation of older Korean female divers, haenyeo: effects of chronic cold exposure and aging.

The aim of the present study was to evaluate the local cold tolerance of older Korean female divers, haenyeo (N = 22) in terms of cold acclimatization and ageing. As control groups, older non-diving females (N = 25) and young females from a rural area (N = 15) and an urban area (N = 51) participated in this study. To evaluate local cold tolerance, finger cold-induced vasodilation (CIVD) during finger immersion of 4 °C water was examined. As a result, older haenyeos showed greater minimum finger temperature and recovery finger temperature than older non-diving females (P < 0.05), but similar responses in onset time, peak time, maximum finger temperature, frequency of CIVD, heart rate, blood pressure, and thermal and pain sensations as those of older non-diving females. Another novel finding was that young urban females showed more vulnerable responses to local cold in CIVD variables and subjective sensations when compared to older females, whereas young rural females had the most excellent cold tolerance in terms of maximum temperature and frequency of CIVD among the four groups (P < 0.05). The present results imply that older haenyeos still retain cold acclimatized features on the periphery even though they changed their cotton diving suits to wet suits in the early 1980s. However, cardiovascular responses and subjective sensations to cold reflect aging effects. In addition, we suggest that young people who have been adapted to highly insulated clothing and indoor heating systems in winter should be distinguished from young people who were exposed to less modern conveniences when compared to the aged in terms of cold tolerance.

Sensitivity to cutaneous warm stimuli varies greatly in the human head.

The head has been known as the most sensitive area to temperature changes but the values are limited to the face. The purpose of this study was to examine cutaneous warm thresholds on the scalp and face of young males. Eight males participated in this study (24 ± 3 yrs in age, 178.2 ± 5.3cm in height, and 90.0 ± 15.4kg in body mass). All measurements were conducted in an environmental chamber (27 ± 1°C air temperature and 53 ± 1% relative humidity). Cutaneous warm thresholds were measured on nine areas of the following regions: the frontal (two points on the right), parietal (a point on the right and the vertex, respectively), temporal (two points on the right), and occipital region (on the right) along with the forehead using a thermal stimulator (rate of temperature increase 0.1°Cs-1). Skin temperatures on the nine head regions were monitored during the threshold test. The results showed that 1) no significant differences were found in initial skin temperatures among the nine head regions; 2) cutaneous warm detecting temperatures were significantly greater on the vertex (38.2 ± 3.5°C) than on the forehead (34.8 ± 1.4°C) and the other seven scalp regions (P < 0.05); 3) subjects detected the increase of 1.2 ± 1.0°C on the forehead and 1.5 ± 1.2°C on the occipital region as the first warmth while the vertex was the most insensitive to the increase of temperature (4.0 ± 3.2°C) (P < 0.05). In summary, the scalp region of young males was less sensitive to the temperature change when compared to the forehead, and the vertex was the most insensitive among the eight scalp regions to the temperature increase. We conclude that the entire head should be considered as a binary topography with the face and the scalp in terms of cutaneous thermal sensitivity.

Indirect hand and forearm vasomotion: Regional variations in cutaneous thermosensitivity during normothermia and mild hyperthermia.

In this experiment, hand and forearm vasomotor activity was investigated during localised, but stable heating and cooling of the face, hand and thigh, under open-loop (clamped) conditions. It was hypothesised that facial stimulation would provoke the most potent vascular changes. Nine individuals participated in two normothermic trials (mean body temperature clamp: 36.6°C; water-perfused suit and climate chamber) and two mildly hyperthermic trials (37.9°C). Localised heating (+5°C) and cooling (-5°C) stimuli were applied to equal surface areas of the face, hand and thigh (perfusion patches: 15min), while contralateral forearm or hand blood flows (venous-occlusion plethysmography) were measured (separate trials). Thermal sensation and discomfort votes were recorded before and during each thermal stimulation. When hyperthermic, local heating induced more sensitive vascular responses, with the combined thermosensitivity of both limb segments averaging 0.011mL·100mL-1·min-1·mmHg-1·°C-1, and 0.005mL·100mL-1·min-1·mmHg-1·°C-1 during localised cooling (P<0.05). Inter-site comparisons among the stimulated sites yielded minimal evidence of variations in local thermal sensation, and no differences were observed for vascular conductance (P>0.05). Therefore, regional differences in vasomotor and sensory sensitivity appeared not to exist. When combined with previous observations of sudomotor sensitivity, it seems that, during mild heating and cooling, regional representations within the somatosensory cortex may not translate into meaningful differences in thermal sensation or the central integration of thermoafferent signals. It was concluded that inter-site variations in the cutaneous thermosensitivity of these thermolytic effectors have minimal physiological significance over the ranges investigated thus far.

Relationships of self-identified cold tolerance and cold-induced vasodilatation in the finger.

This study was conducted to investigate relationships of self-identified cold tolerance and cold-induced vasodilatation (CIVD) in the finger. Nine males and 34 females participated in the following 2 tests: a CIVD test and a self-reported survey. The CIVD test was conducted 30-min cold-water immersion (3.8 ± 0.3 °C) of the middle finger at an air temperature of 27.9 ± 0.1 °C. The self-reported questionnaire consisted of 28 questions about whole and local body cold and heat tolerances. By a cluster analysis on the survey results, the participants were divided into two groups: high self-identified cold tolerance (HSCT, n = 25) and low self-identified cold tolerance (LSCT, n = 18). LSCT had lower self-identified cold tolerance (P < 0.001), preferred hot thermal stimulation (P = 0.006), and wore heavier clothing during daily life (P < 0.001) than HSCT. LSCT had significantly lower maximal finger temperatures (T max) (P = 0.040), smaller amplitude (P = 0.029), and delayed onset time of CIVD (P = 0.080) when compared to HSCT. Some questions examining the self-identified cold or heat tolerance had relationships with cold tolerance index, T max, and amplitude (P < 0.1). These results indicate that self-identified cold tolerance classified through a standardized survey could be a good index to predict physiological cold tolerance.

Na⁺/H⁺ exchanger regulatory factor 3 is critical for multidrug resistance protein 4-mediated drug efflux in the kidney.

Na(+)/H(+) exchanger regulatory factor 3 (NHERF3) is a PSD-95/discs large/ZO-1 (PDZ)-based adaptor protein that regulates several membrane-transporting proteins in epithelia. However, the in vivo physiologic role of NHERF3 in transepithelial transport remains poorly understood. Multidrug resistance protein 4 (MRP4) is an ATP binding cassette transporter that mediates the efflux of organic molecules, such as nucleoside analogs, in the gastrointestinal and renal epithelia. Here, we report that Nherf3 knockout (Nherf3(-/-)) mice exhibit profound reductions in Mrp4 expression and Mrp4-mediated drug transport in the kidney. A search for the binding partners of the COOH-terminal PDZ binding motif of MRP4 among several epithelial PDZ proteins indicated that MRP4 associated most strongly with NHERF3. When expressed in HEK293 cells, NHERF3 increased membrane expression of MRP4 by reducing internalization of cell surface MRP4 and consequently, augmented MRP4-mediated efflux of adefovir, a nucleoside-based antiviral agent and well known substrate of MRP4. Examination of wild-type and Nherf3(-/-) mice revealed that Nherf3 is most abundantly expressed in the kidney and has a prominent role in modulating Mrp4 levels. Deletion of Nherf3 in mice caused a profound reduction in Mrp4 expression at the apical membrane of renal proximal tubules and evoked a significant increase in the plasma and kidney concentrations of adefovir, with a corresponding decrease in the systemic clearance of this drug. These results suggest that NHERF3 is a key regulator of organic transport in the kidney, particularly MRP4-mediated clearance of drug molecules.

Shank2 mutant mice display a hypersecretory response to cholera toxin.

Shank2 is a PDZ (PSD-95/discs large/ZO-1)-based adaptor that has been suggested to regulate membrane transporting proteins in the brain and epithelial tissues. Here, we report that Shank2 mutant (Shank2(-/-)) mice exhibit aberrant fluid and ion transport in the intestine. Molecular characterization using epithelial tissues from Shank2(+/+) and Shank2(-/-) mice revealed that a long spliceoform of Shank2 (Shank2E) is predominantly expressed in the pancreatic, renal and intestinal epithelia. In functional assays, deletion of Shank2 increased the cystic fibrosis transmembrane conductance regulator (CFTR)-dependent short-circuit currents by 84% (P < 0.05) and 101% (P < 0.05) in the mouse colon and rectum, respectively. Disruption of the CFTR-Shank2-phosphodiesterase 4D protein complex appeared to be mostly responsible for the changes in CFTR activities. Notably, Shank2 deletion profoundly increased cholera toxin-induced fluid accumulation in the mouse intestine (∼90%, P < 0.01). Analyses with chemical inhibitors confirmed that the hyperactivation of CFTR channel function is responsible for the increased response to cholera toxin. These results suggest that Shank2 is a key molecule that participates in epithelial homeostasis, in particular to prevent overt secretory responses caused by epithelial pathogens.

Prediction of postoperative pain intensity after lumbar spinal surgery using pain sensitivity and preoperative back pain severity.

OBJECTIVES: To investigate the role of preoperative pain sensitivity and preoperative symptom severity for prediction of postoperative pain intensity after lumbar spine surgery. METHODS: This study consisted of two groups who underwent decompression surgery alone (62 patients) or decompression with fusion surgery (37 patients) for lumbar spinal stenosis (LSS). Pain Sensitivity Questionnaire (PSQ) and visual analog pain scale (VAS) for back pain and leg pain were collected preoperatively with detailed medical history. The assessment was performed immediately after surgery when the patients had completely recovered and regained their complete consciousness from general anesthesia (H0) and subsequently 4, 8, 18, 30, 48, and 72 hours (H4, H8, H18, H30, H48, and H72) thereafter as they recovered. RESULTS: Both groups showed a decrease in back pain and leg pain with the time postoperatively. In fusion group, preoperative VAS for back pain was significantly correlated with postoperative VAS for back pain at H0, H4, H8, and H18, and PSQ minor/total PSQ also showed a significant correlation with postoperative back pain at H48 and H72. In contrast, only total PSQ and PSQ minors were significantly correlated with postoperative back pain at H18 and H30 in decompression group. Hierarchical regression analysis finally showed that each preoperative back pain and PSQ minor was predictive of immediate postoperative back pain (from H0 to H18) in fusion group and delayed postoperative back pain (H18, H30) in decompression group. CONCLUSIONS: The study highlights that each preoperative back pain and individual pain sensitivity could predict the different aspects of postoperative pain after lumbar surgery.

Component contribution of personal protective equipment to the alleviation of physiological strain in firefighters during work and recovery.

The purpose of this study was to investigate the components contributions of personal protective equipment on physiological strain in firefighters during exercise and recovery. Eight firefighters participated in trials in which various combinations of personal protective equipment components weighing from 1.3 to 15.1 kg were worn. The results showed that rectal temperature, changes in rectal temperature, mean skin temperature, heart rate, oxygen consumption and blood lactate concentration were smaller in conditions without boots (no-boots) than in other conditions with no helmet, gloves or self-contained breathing apparatus (P < 0.05). Increases in rectal temperature per unit mass of personal protective equipment were approximately twice as small in no-boots condition as the other conditions. These results suggest that the reduction of the boots' mass might be more efficient to alleviate heat strain of firefighters wearing personal protective equipment, rather than the reduction of the mass of self-contained breathing apparatus, helmet or gloves. PRACTITIONER SUMMARY: As firefighters' protective boots induce greater physiological burden when compared with a helmet, gloves or self-contained breathing apparatus, personal protective equipment designers need to consider the improvement of boots in terms of mass reduction, improvement of thermal comfort and ease of doffing during recovery to alleviate physiological strain on firefighters.

A Method for Straightening Distorted Giga-Cast Large Thin-Walled Components.

Giga-casting, a revolutionary approach for manufacturing large, single-piece car body components from aluminium, has emerged as a potential game-changer in the automotive industry. However, these large, thin-walled castings are prone to distortions during solidification and heat treatment processes. Straightening these distortions is crucial to ensure structural integrity, facilitate downstream assembly, and maintain aesthetic qualities. This paper proposes a novel method for straightening giga-cast components using a multi-pin straightening machine. The machine's versatility stems from its ability to adapt to various geometries through multiple strategically controlled straightening pins. This paper introduces the concept of a "straightening stroke decision algorithm" to achieve precise straightening and overcome the challenges of complex shapes. This algorithm determines the stroke length for each pin, combining a polynomial model representing the global stiffness of the component with a machine learning model that captures the stiffness changes arising from the current geometry. The effectiveness of the proposed approach is evaluated through comprehensive numerical experiments using finite element analyses. The straightening performance is assessed for the straightening algorithm with different machine learning models (deep neural network and XGBoost) and compared to a traditional optimisation method. The proposed surrogate models decided the straightening strokes so that the maximum remaining distortion became 0.02% of the largest dimension of each target geometry. The results of the numerical experiment showed that the proposed straightening method is suitable for straightening distortion in large thin-walled components.

The Application of Virtual Reality in Shoulder Surgery Rehabilitation.

To achieve a positive functional prognosis in orthopedic surgery, particularly in shoulder surgeries, effective rehabilitation is essential. Recently, there has been growing interest in the use of virtual reality (VR) in the field of orthopedics, particularly for preoperative education and training, as well as clinical and home-based rehabilitation. This report describes the process of developing an application utilizing Meta Quest 2 VR technology (Meta, CA, USA) for rehabilitation after shoulder surgery. This application assists patients in performing postoperative exercises at home by wearing VR equipment tailored to their postoperative weeks. The advantages of VR rehabilitation lie in overcoming the limitations of traditional rehabilitation methods and providing patients with a better rehabilitation experience. Moreover, automating the rehabilitation process and reducing patients' visits to clinics can lead to cost savings. This report raises expectations for the potential and scalability of VR utilization, extending beyond orthopedics to other fields. In addition, it anticipates that with better feedback and motivation, the rehabilitation effects for patients can be further enhanced.

Association of genetic variation in chitotriosidase with atopy in Korean children.

BACKGROUND: The atopic diseases, which are the most common chronic diseases of childhood, are complex genetic diseases that involve the contribution of multiple genetic factors to disease pathophysiology. Chitotriosidase is involved in innate immunity, but the association of chitotriosidase with allergic diseases remains unclear. OBJECTIVE: To examine the contribution of genetic variation of the chitotriosidase-encoding gene CHIT1 to atopic phenotypes in a Korean cohort of children. METHODS: We identified CHIT1 variations in a Korean population and conducted association analyses using 295 atopic and 242 nonatopic children. An independent replication study was performed using DNA samples from 148 atopic and 243 nonatopic children. All children were unrelated. We performed Western blot analysis in each genotype in vitro to see whether the CHIT1 A442G variation affects the final protein expression levels. RESULTS: In the case-control association analysis, atopy was significantly associated with a single A442G (rs1065761) polymorphism in CHIT1 (odds ratio = 1.32, P = .01). Children with the c.442G risk allele had significantly higher blood eosinophils (P = .001), total serum IgE (P = .007), and eosinophil cationic protein (P = .02) levels. The results of the replication stage analysis confirmed a significant association between the A442G polymorphism and childhood atopy. The joint analysis of the exploratory and replication studies displayed a stronger significant association. The relative protein expression levels of chitotriosidase were significantly higher in both cell lysate and media with the G transfection compared with the wild type. CONCLUSION: These results indicate that the nonsynonymous A442G polymorphism in CHIT1 is associated with risk of atopy.