A staged use of tourniquet does not influence the fast-track recovery after total knee arthroplasty: a prospective randomized study.

INTRODUCTION: Upper-tight tourniquet is widely used in Total Knee Arthroplasty in different modalities. However, it has been associated with a negative impact on post-operative muscle strength end pain. This study aimed to investigate the effect of tourniquet on post-operative pain and recovery in enhanced recovery joint surgery. MATERIALS AND METHODS: In this prospective randomized study, we included 116 patients undergoing to TKA. Surgery was performed with a staged use of tourniquet in Group A (58 patients) and without tourniquet in Group B. In the former group a low-pressure tourniquet was deflated after bone cuts to allow hemostasis of posterior recess and re-inflated for cementation. For all patients a multimodal fast-track recovery protocol was used. Time to reach rehabilitation milestones was recorded as primary endpoint. Range of motion, pain, hemarthrosis, total blood loss, surgical field visualization, Knee Score (KS) and Oxford Knee Score (OKS) were considered as secondary outcomes. RESULTS: . No statistically significant differences were found (group B: average 1.3 ± 0.6 day; group A: average 1.2 ± 0.5 day). Group A had a shorter mean surgical time and a clearer surgical field visualization. Group B had a larger estimated blood loss and hemoglobin drop without a statistically significant difference in the transfusion rate. No differences between the groups were seen in the KS, OKS and range of motion (ROM) and post-operative joint swelling. Pain score was similar between cohorts and recorded thigh pain was surprisingly greater in group B. DISCUSSION: The use of tourniquet in TKA surgery helps to minimize intraoperative blood loss and improves surgical field visualization. Its application with a modern and staged protocol does not affect the functional outcomes (OKS, KSS, ROM) of the early post operative period without compromising the fast-track recovery.

Epiphyseal fixation in revision total knee arthroplasty: a comparison between trabecular metal and titanium augments.

INTRODUCTION: The purpose of this retrospective study was to compare the medium-term clinical and radiographic outcomes of two series of patients treated for revision TKA: one implanted with trabecular metal (TM) augments and one implanted with classic titanium augments. MATERIALS AND METHODS: A total of 85 patients with a type 2 AORI defect underwent revision TKA and were treated either with TM epiphyseal augments directly screwed in the bone or with traditional titanium augments. There were 46 patients in the TM group and 39 patients in the titanium group included in the study. All the patients received the same varus-valgus constrained implant and no metaphyseal fixation devices were used. RESULTS: After a mean follow-up of 66.4 months, no statistically significant difference was observed in terms of failure for aseptic loosening between the two groups (4% in the TM group and 7.8% in the titanium group, p = 0.35). The ten-year survival using aseptic loosening as endpoint was 90.5% (95% CI 94.1-98.6) in the TM group and 85% (95% CI 101.9-119.3) in the titanium group (p = 0.26). A statistically significant difference was detected for the presence of RLL. No RLL were found under the studied TM augments compared to 13.7% of the titanium augments (p = 0.01). CONCLUSION: The use of TM augments directly screwed to the epiphysis of the femur and the tibia reduced the incidence of RLL compared to standard titanium augments during revision TKA with promising medium-term results.

Predictors of well-being, future anxiety, and multiple recurrent health complaints among university students during the COVID-19 pandemic: the role of socioeconomic determinants, sense of coherence, and digital health literacy. An Italian cross-sectional study.

The pandemic deeply changed young adults' life. Lockdown period and the social restrictions dramatically affected university students' mental health. The aim of our cross-sectional study was to describe psychological well-being, future anxiety (FA), and health complaints (HCs) in a sample of 3,001 students of the University of Florence in the middle of the first two pandemic waves. We assessed the role of subjective social status, chronic diseases, sense of coherence (SoC), and digital health literacy (DHL) as predictors of psychological well-being, FA, and HCs. Students expressed high levels of FA and reported being disturbed by not being able to achieve their desired future goals. About 40% reported a low or a very low well-being and 19.1% experienced two or more subjective health complaints more than once a week. The likelihood of having a better mental health status significantly increased with increasing SoC and among males. Subjective Social Status proved to be a predictor for FA. Enhancing SoC could improve the health status of the university students during the pandemic and beyond.

Inferior results at long-term follow-up after extensor mechanism allograft reconstruction in septic compared to aseptic revision total knee arthroplasty.

PURPOSE: Extensor mechanism lesion after total knee arthroplasty (TKA) is a catastrophic complication. Reconstruction with extensor mechanism allograft (EMA) has been described as a sound salvage procedure. Its effectiveness at long term and in septic cases is still under scrutiny. The long-term results of EMA reconstruction for chronic extensor mechanism failures following aseptic and septic revision TKA have been analysed. METHODS: From the institutional database, 35 patients with a revision TKA (RevTKA) undergoing EMA reconstruction from 2005 to 2015 have been retrospectively identified. A history of periprosthetic joint infection (PJI) was found in 13 (37%) patients. The mean follow-up was 81.2 months (± 34.7, range 3-120). EMA failures were considered for lag more than 20°, Knee Society Score (KSS) less than 60 points, and/or in the case of revision of the allograft. RESULTS: The mean KSS improved from 35.9 (± 16.9, range 0-54) to 86.6 (± 10.4, range 54-99) points in the aseptic group (p < 0.001) and from 27.5 (± 11.6, range 10-44) to 79.4 (± 16.3, range 48-94) points in the septic group (p < 0.001). The extensor lag changed from 48.4° (± 14.5, range 30-90) to 4.6° (± 10.8, range 0-50) in the aseptic group (p < 0.001) and from 56.5° (± 20.8, range 30-90) to 6.1° (± 6.8, range 0-20) in the septic group (p < 0.001). The mean postoperative flexion was 105.2° (± 13.2, range 75-130) in the aseptic group and 102.7° (± 12.5, range 80-120) in the septic group (p = 0.32). Three failures (14% of the cases) occurred in the aseptic group and five in the septic group (38% of the cases). The overall survivorship at 10 years was 83.3% (22 cases, CI95 94.2-121.7) vs 58% (13 cases, CI95 67.2-111.7) in the aseptic and septic group, respectively (p = 0.01). CONCLUSIONS: EMA reconstruction after extensor mechanism disruptions in TKA is a reliable salvage procedure. The septic nature of the revision decreased the functionality of the knee joint after EMA, but it did not represent a risk factor for re-ruptures or recurrence of infection. LEVEL OF EVIDENCE: Level III.

Biostimulant Formulations and Moringa oleifera Extracts to Improve Yield, Quality, and Storability of Hydroponic Lettuce.

The urgent need to increase the sustainability of crop production has pushed the agricultural sector towards the use of biostimulants based on natural products. The current work aimed to determine whether the preharvest application of two commercial formulations, based on a Fabaceae enzymatic hydrolysate or a blend of nitrogen sources including fulvic acids, and two lab-made aqueous extracts from Moringa oleifera leaves (MLEs), could improve yield, quality, and storability of lettuce grown in a hydroponic system, as compared to an untreated control. Lettuce plants treated with the MLEs showed significantly improved quality parameters (leaf number, area, and color), total phenolic content and antioxidant activity, and resistance against the fungal pathogen Botrytis cinerea, comparable to that obtained with commercial formulates, particularly those based on the protein hydrolysate. A difference between the M. oleifera extracts was observed, probably due to the different compositions. Although further large-scale trials are needed, the tested MLEs seem a promising safe and effective preharvest means to improve lettuce agronomic and quality parameters and decrease susceptibility to rots.

Investigating Adherence to COVID-19 Vaccination and Serum Antibody Concentration among Hospital Workers-The Experience of an Italian Private Hospital.

SARS-CoV-2 transmission has been high, especially among healthcare workers worldwide during the first wave. Vaccination is recognized as the most effective approach to combat the pandemic, but hesitation to get vaccinated represents an obstacle. Another important issue is the duration of protection after administration of the full vaccination cycle. Based on these premises, we conducted a study to evaluate vaccination adherence and the anti-S antibodies levels among hospital workers, from January to March, 2021. To assess adherence, an anonymous questionnaire was used. Anti-S antibody levels were obtained from the monitoring serological sample database. In total, 56.2% of the unvaccinated people did not report a previous infection from COVID-19. Among those who have not been vaccinated, 12.5% showed distrust against the vaccine, 8.3% stated to have received contraindications to the vaccination, and 6.3% did not report any choice. Analyzing anti-S antibody levels, only one person was found to have a value below the lower cut-off, two weeks, and three months after receiving their second dose. One was below the cut-off after two weeks, and then above the same cut-off after three months. The results of our survey should be seen as a stimulus to further sensitize hospital staff to the importance of vaccination and pay attention to anti-S antibody levels monitoring.

The Nutrition Literacy Assessment Instrument for Italian Subjects, NLit-IT: Exploring Validity and Reliability.

The aim of this study was to test validity and reliability of the adapted version of the Nutrition Literacy Assessment Instrument (NLit) for Italian people (NLit-IT). An observational cross-sectional study was conducted, involving a convenience sample of adults (n = 74). To explore the validity of the tool, we considered both diet quality as an outcome of NL, and health literacy (HL) as a construct that presents similarities and differences with NL. Diet quality was measured by adherence to the Mediterranean Diet (Med diet) through the validated Mediterranean Diet Literature-based adherence score (MEDI-Lite). The relationship between NL level and adherence to Med diet was assessed by linear regression analysis and computing correlations between NLit-IT and MEDI-Lite scores (Spearman's Rho). Additionally, we evaluated the correlation between NLit-IT score and the level of HL (Spearman's Rho). Internal consistency and reliability were measured by Cronbach's alpha and intraclass correlation coefficient (ICC) respectively. Internal consistency (ρT = 0.78; 95% CI, 0.69-0.84) and reliability (ICC = 0.68, 95% CI, 0.46-0.85) were confirmed. In addition, NLit-IT total score was correlated with MEDI-Lite score (Rho = 0.25; p-value = 0.031) and multivariate regression analysis confirmed that NL significantly contributed to MEDI-Lite score (R2 = 0.13; ß = 0.13; p-value = 0.008). There was no significant association between the level of HL and NL. In conclusion, NLit-IT showed validity and reliability as a measure of NL for Italian people.

Behavioral effects induced by organic insecticides can be exploited for a sustainable control of the Orange Spiny Whitefly Aleurocanthus spiniferus.

The Orange Spiny Whitefly (OSW) Aleurocanthus spiniferus (Hemiptera: Aleyrodidae) represents a new serious threat to Citrus spp., grapevine and ornamental plants in the whole Mediterranean area. Such threat urgently calls for the development of a sustainable control strategy, including insecticides compatible with biological control, and applicable also in organic citrus farming that represent an essential part of Mediterranean agricultural economy. Therefore, we evaluated the toxicity and the effects on host searching, oviposition, and probing and feeding behavior exerted on OSW by organic insecticides supposed to have limited side effects on environment and ecosystem services, i.e. sweet orange essential oil (EO), extract of Clitoria ternatea (CT), mineral oil, pyrethrin and azadirachtin. Despite none of the compounds caused a significant mortality of any of the OSW instars, we observed interesting effects on whitefly behavior: (i) EO and pyrethrin showed a relevant repellent effect, with impairment of both adults landing and oviposition on treated plants; (ii) CT and pyrethrin strongly affected probing behavior. Here, in the light of our findings, we discuss possible OSW sustainable control strategies and further research perspectives.

A Systematic Review of Risk Assessment Associated with Jellyfish Consumption as a Potential Novel Food.

FAO (Food and Agriculture Organization of the United Nations) predicted that the world's population will reach over 9 billion in 2050. This condition will require an increase of the global food production by 60%. Technology and scientific research in the near future will soon be oriented towards optimizing the limited existing resources, reducing waste, and improving the consumption of sustainable new foods. Jellyfish could be a valid alternative among novel food. The purpose of this systematic review was to assess microbiological, chemical, physical, and allergenic risks associated with jellyfish consumption. Four research strings have been used to assess evidences about these risks. PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-analysis) guidelines were applied. Finally, 14 articles were found. Results showed a good level of health safety for jellyfish consumption in terms of its allergenic and microbiological risks. No evidence was found about physical risks. As regards chemical safety, it should be fundamental to carry out a constant monitoring of the water where jellyfish are captured or bred. Periodic checks will be necessary on the finished product, such as the analysis of the aluminum content commonly used during the manufacturing process. The number of publications found was rather small, and further investigation will be necessary to enforce the knowledge on jellyfish consumption by humans.

Whole-body isometric force/torque measurements for functional assessment in neuro-rehabilitation: user interface and data pre-processing techniques.

A diagnostic platform for the early functional assessment of post-stroke patients was designed in order to perform isometric measurements during activities of daily living (ADL) tasks. The outcome of these measurements can contribute to verify the integrity of a post-stroke existing or altered "internal model" for a particular functional task. A complete and reliable software application for the diagnostic platform was designed, developed and tested in three European hospitals. The software application was divided into two main modules: a graphical user interface (GUI) and the data pre-processing techniques for the interpretation of recorded biomedical and clinical data. This paper presents the software application associated to the platform, aimed at analysing and interpreting the huge amount of data recorded and collected during the experimental trials. Its main objective is related to validating the onset detection and data reduction. The software application presented in this paper has been working and validated with success in three different clinical centres in Europe and it can be effectively used both as assessment tool in rehabilitation and as research tool in neuroscience.

A mechatronic platform for behavioral analysis on nonhuman primates.

In this work we present a new mechatronic platform for measuring behavior of nonhuman primates, allowing high reprogrammability and providing several possibilities of interactions. The platform is the result of a multidisciplinary design process, which has involved bio-engineers, developmental neuroscientists, primatologists, and roboticians to identify its main requirements and specifications. Although such a platform has been designed for the behavioral analysis of capuchin monkeys (Cebus apella), it can be used for behavioral studies on other nonhuman primates and children. First, a state-of-the-art principal approach used in nonhuman primate behavioral studies is reported. Second, the main advantages of the mechatronic approach are presented. In this section, the platform is described in all its parts and the possibility to use it for studies on learning mechanism based on intrinsic motivation discussed. Third, a pilot study on capuchin monkeys is provided and preliminary data are presented and discussed.

Human movement onset detection from isometric force and torque measurements: a supervised pattern recognition approach.

OBJECTIVE: Recent research has successfully introduced the application of robotics and mechatronics to functional assessment and motor therapy. Measurements of movement initiation in isometric conditions are widely used in clinical rehabilitation and their importance in functional assessment has been demonstrated for specific parts of the human body. The determination of the voluntary movement initiation time, also referred to as onset time, represents a challenging issue since the time window characterizing the movement onset is of particular relevance for the understanding of recovery mechanisms after a neurological damage. Establishing it manually as well as a troublesome task may also introduce oversight errors and loss of information. METHODS: The most commonly used methods for automatic onset time detection compare the raw signal, or some extracted measures such as its derivatives (i.e., velocity and acceleration) with a chosen threshold. However, they suffer from high variability and systematic errors because of the weakness of the signal, the abnormality of response profiles as well as the variability of movement initiation times among patients. In this paper, we introduce a technique to optimise onset detection according to each input signal. It is based on a classification system that enables us to establish which deterministic method provides the most accurate onset time on the basis of information directly derived from the raw signal. RESULTS: The approach was tested on annotated force and torque datasets. Each dataset is constituted by 768 signals acquired from eight anatomical districts in 96 patients who carried out six tasks related to common daily activities. The results show that the proposed technique improves not only on the performance achieved by each of the deterministic methods, but also on that attained by a group of clinical experts. CONCLUSIONS: The paper describes a classification system detecting the voluntary movement initiation time and adaptable to different signals. By using a set of features directly derived from raw data, we obtained promising results. Furthermore, although the technique has been developed within the scope of isometric force and torque signal analysis, it can be applied to other detection problems where several simple detectors are available.

Double nerve intraneural interface implant on a human amputee for robotic hand control.

OBJECTIVES: The principle underlying this project is that, despite nervous reorganization following upper limb amputation, original pathways and CNS relays partially maintain their function and can be exploited for interfacing prostheses. Aim of this study is to evaluate a novel peripheral intraneural multielectrode for multi-movement prosthesis control and for sensory feed-back, while assessing cortical reorganization following the re-acquired stream of data. METHODS: Four intrafascicular longitudinal flexible multielectrodes (tf-LIFE4) were implanted in the median and ulnar nerves of an amputee; they reliably recorded output signals for 4 weeks. Artificial intelligence classifiers were used off-line to analyse LIFE signals recorded during three distinct hand movements under voluntary order. RESULTS: Real-time control of motor output was achieved for the three actions. When applied off-line artificial intelligence reached >85% real-time correct classification of trials. Moreover, different types of current stimulation were determined to allow reproducible and localized hand/fingers sensations. Cortical organization was observed via TMS in parallel with partial resolution of symptoms due to the phantom-limb syndrome (PLS). CONCLUSIONS: tf-LIFE4s recorded output signals in human nerves for 4 weeks, though the efficacy of sensory stimulation decayed after 10 days. Recording from a number of fibres permitted a high percentage of distinct actions to be classified correctly. Reversal of plastic changes and alleviation of PLS represent corollary findings of potential therapeutic benefit. SIGNIFICANCE: This study represents a breakthrough in robotic hand use in amputees.

Whole-body isometric force/torque measurements for functional assessment in neuro-rehabilitation: platform design, development and verification.

BACKGROUND: One of the main scientific and technological challenges of rehabilitation bioengineering is the development of innovative methodologies, based on the use of appropriate technological devices, for an objective assessment of patients undergoing a rehabilitation treatment. Such tools should be as fast and cheap to use as clinical scales, which are currently the daily instruments most widely used in the routine clinical practice. METHODS: A human-centered approach was used in the design and development of a mechanical structure equipped with eight force/torque sensors that record quantitative data during the initiation of a predefined set of Activities of Daily Living (ADL) tasks, in isometric conditions. RESULTS: Preliminary results validated the appropriateness, acceptability and functionality of the proposed platform, that has become now a tool used for clinical research in three clinical centres. CONCLUSION: This paper presented the design and development of an innovative platform for whole-body force and torque measurements on human subjects. The platform has been designed to perform accurate quantitative measurements in isometric conditions with the specific aim to address the needs for functional assessment tests of patients undergoing a rehabilitation treatment as a consequence of a stroke.The versatility of the system also enlightens several other interesting possible areas of application for therapy in neurorehabilitation, for research in basic neuroscience, and more.

Brain activity preceding a 2D manual catching task.

We investigated the event-related desynchronization (ERD) and synchronization (ERS) properties of cortical EEG rhythms in regions of interest (ROI) during the preparation of a 2D task for manual catching of a moving object. EEG signals were recorded through a 32-channel system in eleven healthy subjects during the interception task consisting of 2D catching with the right hand of a handle moving at constant velocity (1.5 m/s) on a predefined straight trajectory. The first session of catching movements (CATCHING_PRE) was compared with a second session after 1 h with identical characteristics (CATCHING_POST) and with other two conditions, where the subjects had to reach and grasp the handle fixed in the medium of platform (REACHING) and they looked at the object moving without catching it (GAZE TRACKING). Changes of cortical rhythms were correlated with dynamic and kinematic indexes of motor performance in both catching sessions. Movements requiring different strategies (predictive versus prospective) are supported by specific changes of cortical EEG rhythms: in the CATCHING condition a more evident power decrease (ERD) in alpha 2 and beta band in the sensorimotor region contralateral to the catching hand was observed, while in the REACHING one a bilateral ERD in beta band was found. Motor learning and movement automatization were characterized by a significant reduction of theta ERS in the anterior cingulate cortex (ACC), a ROI linked to focused attention, and with a shift of neuronal activation in alpha 2 band from the bilateral superior parietal areas to the homologous area of the left hemisphere. Finally, our EEG findings are consistent with the role of supplementary motor (SMA), premotor and prefrontal areas in motor planning and preparation. In particular, theta ERS in left SMA significantly correlated with an improvement of motor performance, as evidenced by its correlation with the training-related reduction of interception time (IT).