Experimental assessment of pelvis slipping during postless traction for orthopaedic applications.

BACKGROUND: The application of lower limb traction during hip arthroscopy and femur fractures osteosynthesis is commonplace in orthopaedic surgeries. Traditional methods utilize a perineal post on a traction table, leading to soft tissue damage and nerve neuropraxia. A postless technique, using high-friction pads, has been considered as a potential damage-free alternative. However, whether these pads sufficiently prevent patient displacement remains unknown. Thus, this study systematically assesses the efficacy of commercial high-friction pads (PinkPad and CarePad) in restraining subject displacement, for progressively increasing traction loads and different Trendelenburg angles. METHODS: Three healthy male subjects were recruited and tested in supine and Trendelenburg positions (5° and 10°), using a customized boot-pulley system. Ten load disks (5 kg) were dropped at 15s intervals, increasing gradually the traction load up to 50 kg. Pelvis displacement along the traction direction was measured with a motion capture system. The displacement at 50 kg of traction load was analyzed and compared across various pads and bed inclinations. Response to varying traction loads was statistically assessed with a quadratic function model. RESULTS: Pelvis displacement at 50 kg traction load was below 60 mm for all conditions. Comparing PinkPad and CarePad, no significant differences in displacement were observed. Finally, similar displacements were observed for the supine and Trendelenburg positions. CONCLUSIONS: Both PinkPad and CarePad exhibited nearly linear behavior under increasing traction loads, limiting displacement to 60 mm at most for 50 kg loads. Contrary to expectations, placing subjects in the Trendelenburg position did not increase adhesion.

Randomised controlled, patient-blinded, multicentre, superiority trial to evaluate the efficacy of the line-attached sheath-type traction device for endoscopic submucosal dissection in patients with superficial gastric neoplasms.

INTRODUCTION: EndoTrac is a line-attached sheath-type traction device that enables us to control the direction and the force of traction during endoscopic submucosal dissection (ESD). The efficacy of EndoTrac for gastric ESD has not been fully verified. METHODS AND ANALYSIS: The G-Trac study is a multicentre (nine general hospitals and two university hospitals in Japan) collaborative trial assessing the efficacy of EndoTrac for gastric ESDs. Patients with superficial gastric neoplasms will be enrolled and randomly assigned to undergo either conventional ESD or EndoTrac ESD. Allocation will be stratified according to tumour location, operator experience and tumour diameter at an allocation rate of 1:1. The type of endoknife used will be confirmed before randomisation. The primary outcome, procedure time, will be compared between the groups in both intention-to-treat and per-protocol analyses using the Wilcoxon rank sum test. The efficacy-related, safety-related and device-related outcomes will be assessed in the secondary analysis. The planned sample size of the 142 patients in the two groups will enable us to detect a difference with a power of 80% by using the Wilcoxon rank sum test, assuming an effect size of 0.54, asymptotic relative efficiency of 0.864 and a two-sided type 1 error rate of 5%. ETHICS AND DISSEMINATION: This trial was approved by the certified review board of Kobe University (22 December 2022). The results from this trial will be disseminated through peer-review journals, presentations at national and international conferences, and data sharing with other researchers. TRIAL REGISTRATION NUMBER: jRCT1052220166.

Revelation of adhesive proteins affecting cellular contractility through reference-free traction force microscopy.

Over the past few decades, the critical role played by cellular contractility associated mechanotransduction in the regulation of cell functions has been revealed. In this case, numerous biomaterials have been chemically or structurally designed to manipulate cell behaviors through the regulation of cellular contractility. In particular, adhesive proteins including fibronectin, poly-L-lysine and collagen type I have been widely applied in various biomaterials to improve cell adhesion. Therefore, clarifying the effects of adhesive proteins on cellular contractility has been valuable for the development of biomaterial design. In this study, reference-free traction force microscopy with a well-organized microdot array was designed and prepared to investigate the relationship between adhesive proteins, cellular contractility, and mechanotransduction. The results showed that fibronectin and collagen type I were able to promote the assembly of focal adhesions and further enhance cellular contraction and YAP activity. In contrast, although poly-L-lysine supported cell spreading and elongation, it was inefficient at inducing cell contractility and activating YAP. Additionally, compared with cellular morphogenesis, cellular contraction was essential for YAP activation.

[Emphasizing the timing and procedure selection for vitrectomy in pathological myopic traction maculopathy].

Myopic maculopathy is the primary cause of irreversible visual impairment in patients with pathologic myopia, and myopic traction maculopathy often requires vitrectomy for treatment. Myopic traction maculopathy encompasses epiretinal membrane, foveoschisis, macular hole, and macular hole-related retinal detachment. It is recommended to perform vitrectomy combined with inner limiting membrane peeling for Type II epiretinal membrane, foveal-sparing inner limiting membrane peeling for foveoschisis, inverted inner limiting membrane flap technique for macular hole, and vitrectomy combined with macular buckle for refractory macular hole-related retinal detachment. Myopic traction maculopathy is a chronically progressive condition, and surgeons need to accurately determine the timing of surgery and choose appropriate procedures to maximize the benefits for patients.

Three different surgical positions on radiological outcomes in the proximal femoral nail: supine, lateral decubitus and traction table.

OBJECTIVE: While the proximal femoral nail (PFN) is deemed a successful therapeutic approach for intertrochanteric femoral fractures, medical professionals lack agreement as to the optimal surgical positioning. Our objective was to determine the radiological superiorities of three different surgical positions (supine, lateral decubitus, and traction table). PATIENTS AND METHODS: In this clinical study, 157 prospectively followed-up patients who were operated with PFN for intertrochanteric femur fractures between 2019 and 2022 were analyzed retrospectively. The demographic data of the patients, fracture type, preparation and surgery duration, recorded number of fluoroscopy shots, femoral neck quadrant of the lag screw, tip-apex distance, collodiaphyseal angle, and reduction quality were evaluated. RESULTS: Of the 157 patients evaluated in the study, 35 patients (22.3%) were operated in the supine position without traction table, 52 patients (33.1%) in the lateral decubitus position, and 70 patients (44.6%) in the supine position with a traction table. Significant differences were found between groups in terms of preparation duration (p<0.001) and number of fluoroscopy shots (p<0.001). Post-hoc analyses revealed that the preparation duration and the number of fluoroscopy shots were significantly lower in the supine position with manual traction. In radiological examinations, significant differences were found between the groups in all radiological parameters evaluated. Post-hoc analyses showed that the use of the traction table is associated with the lag screw quadrant (p<0.001), the reduction quality (p<0.001), the tip-apex distance (p=0.011), and the collodiaphyseal angle (p<0.001). CONCLUSIONS: Despite the disadvantages, such as prolonged preparation duration and increased fluoroscopy usage, the use of a traction table stands out in PFN due to superior radiological results, such as a more successful reduction quality, a more accurately positioned lag screw and ideal tip-apex distance, and collodiaphyseal angulation.

Central Cord Syndrome After Fall From Inversion Table.

INTRODUCTION: Central cord syndrome, the most common incomplete traumatic spinal cord injury, often results in functional impairment with variable recovery. CASE PRESENTATION: Central cord syndrome developed in a 64-year-old man during routine home use of an inversion table. DISCUSSION: The incidence of central cord syndrome, which occurs most frequently after a fall, is increasing among older persons. Age-related changes in the cervical spine may predispose the spinal cord to compression and injury during a fall. Evidence for lumbar traction as treatment of low back pain is limited. CONCLUSIONS: This unusual case of spinal cord injury during inversion table use highlights the relationship between anatomical changes in the cervical spine and the mechanism of injury typical in central cord syndrome. The resulting increased risk of central cord syndrome for older adults should be discussed with patients in the context of activities that could lead to falls or cervical spine extension.

The immediate effect of cervical rotation-traction manipulation on cervical paravertebral soft tissue: a study using soft tissue tension cloud chart technology.

BACKGROUND: To evaluate the reliability of the Soft Tissue Tension Cloud Chart (STTCC) technology, an original method combining multi-point Cervical Paravertebral Soft Tissue Test (CPSTT) with MATLAB software, we conducted a preliminary analysis on the immediate effects of Orthopaedic Manual Therapy (OMT) on cervical paravertebral soft tissue. METHODS: 30 patients with Cervical Spondylotic Radiculopathy (CSR) were included in this study. We analyzed the differences in CPSTT before and after treatment with Cervical Rotation-Traction Manipulation (CRTM), a representative OMT technique in Traditional Chinese Medicine, using the STTCC technology. RESULTS: The STTCC results demonstrated that post-treatment CPSTT levels in CSR patients were significantly lower than pre-treatment levels after application of CRTM, with a statistically significant difference (P < 0.001). Additionally, pre-treatment CPSTT levels on the symptomatic side (with radicular pain or numbness) were higher across the C5 to C7 vertebrae compared to the asymptomatic side (without symptoms) (P < 0.001). However, this difference disappeared after CRTM treatment (P = 0.231). CONCLUSIONS: The STTCC technology represents a reliable method for analyzing the immediate effects of OMT. CSR patients display uneven distribution of CPSTT characterized by higher tension on the symptomatic side. CRTM not only reduces overall cervical soft tissue tension in CSR patients, but can also balance the asymmetrical tension between the symptomatic and asymptomatic sides. TRIAL REGISTRATION: This study was approved by the Chinese Clinical Trials Registry (Website: . https://www.chictr.org.cn .) on 20/04/2021 and the Registration Number is ChiCTR2100045648.

Research on modification and noise reduction optimization of Electric Multiple Units traction gear under multiple working conditions.

The vibration and radiation noise characteristics of the gear transmission system are different under different traction conditions, and the gear modification optimization scheme based on a single working condition is not suitable for the operating environment under all working conditions. To modify the traction gear of a high-speed EMU, an optimized design scheme for noise reduction under multiple working conditions is proposed. A modification plan of the tooth direction in conjunction with the tooth shape was devised using a parametric model of the EMU's traction gear transmission system. The radiation noise of the gear transmission system after modification was solved using the acoustic boundary element method under different working conditions. A gear noise prediction model based on the random forest was proposed, and a gear modification parameter combination was constructed to minimize radiation noise. Then, the optimal design scheme of multi-condition modification combination parameters is obtained with the weight of the running time and acoustic contribution under different working conditions. The grey correlation degree evaluation model is established to verify that the multi-condition modification optimization design method can make the traction gear of EMU obtain satisfactory transmission performance and noise reduction effect under different working conditions.