Brake response time before and after total knee arthroplasty: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Although the numbers of total knee arthroplasty (TKA) are increasing, there is only a small number of studies investigating driving safety after TKA. The parameter 'Brake Response Time (BRT)' is one of the most important criteria for driving safety and was therefore chosen for investigation.</p> <p>The present study was conducted to test the hypotheses that patients with right- or left-sided TKA show a significant increase in BRT from pre-operative (pre-op, 1 day before surgery) to post-operative (post-op, 2 weeks post surgery), and a significant decrease in BRT from post-op to the follow-up investigation (FU, 8 weeks post surgery). Additionally, it was hypothesized that the BRT of patients after TKA is significantly higher than that of healthy controls.</p> <p>Methods</p> <p>31 of 70 consecutive patients (mean age 65.7 +/- 10.2 years) receiving TKA were tested for their BRT pre-op, post-op and at FU. BRT was assessed using a custom-made driving simulator. We used normative BRT data from 31 healthy controls for comparison.</p> <p>Results</p> <p>There were no significant increases between pre-op and post-op BRT values for patients who had undergone left- or right-sided TKA. Even the proportion of patients above a BRT threshold of 700 ms was not significantly increased postop. Controls had a BRT which was significantly better than the BRT of patients with right- or left-sided TKA at all three time points.</p> <p>Conclusion</p> <p>The present study showed a small and insignificant postoperative increase in the BRT of patients who had undergone right- or left-sided TKA. Therefore, we believe it is not justified to impair the patient's quality of social and occupational life post-surgery by imposing restrictions on driving motor vehicles beyond an interval of two weeks after surgery.</p

Deciphering the transcription factors that regulate the NKG2D ligand MICA in cancer cells

Natural Killer (NK) cells constitute a significant part of the innate immune system that show spontaneous cytolytic activity against tumor cells. Their function is tightly regulated by a variety of inhibitory and activating receptors. NKG2D is one of the most prominent activating receptors. Ligands for NKG2D (NKG2D-Ls), such as MHC class I polypeptide-related sequence A (MICA), are generally induced on the surface of malignant cells. However, tumor cells develop mechanisms to evade innate immune surveillance. The mechanisms include down-regulation of ligand expression, proteolytic shedding, and release of soluble NKG2D-L to render the target cells invisible for the NKG2D-dependent NK cell activity. Previously we showed that the treatment with the histone deacetylase inhibitor (HDACi) LBH589 upregulates the expression of NKG2D-L in mouse and human cells. Nevertheless, the mechanisms regulating NKG2D-L expression upon LBH589 treatment remain elusive. To gain insight into the complex regulation of NKG2D-L MICA promoter on a chromatin level, a CRISPR/dCas9 system-based chromatin immunoprecipitation (enChIP) in combination with mass spectrometry was established as a powerful novel method for identifying DNA-binding molecules. As a result, I could identify, among others, the zinc finger transcription factor KLF4, which can act either as an oncogene or as a tumor suppressor in different cancers depending on the tumor types or stages. Genetic/pharmacological gain and loss of function experiments in acute myeloid leukemia (AML) cells revealed that the inducible MICA expression was associated with the expression of KLF4. Notably, the phase 1 clinical-stage molecule APTO253, known to promote cell cycle arrest and apoptosis, induces the expression of KLF4 in AML cells. This induction was associated with an increased expression of NKG2D-L, thus rendering resistant AML cell lines susceptible to NK cell-mediated killing. These findings shed light on a strong rationale for targeting AML patients by KLF4 induction, using APTO253 in combination with adoptive NK cell transfer to eliminate AML blasts

Effect of Stratification and Joule Heating on MHD Dusty Viscoelastic Fluid Flow Through Inclined Channels in Porous Medium in Presence of Molecular Diffusivity

An analysis is carried out to study laminar MHD convection flow of a second order dusty viscoelastic fluid in porous medium through an inclined parallel plate channel in the presence of molecular diffusivity. The plates are maintained at two different temperatures that decay with time. The study is done under the consideration that viscosity and density of the fluid are variable to the extent that it causes stratification and joule heating effect in the process of the flow. The purpose of the study is to examine how stratification and joule heating affect the flow in relation to the physical quantities namely, Stratification factor, Hartmann number, Viscoelastic coefficient, Joule heating parameter, Prandtl number, Eckert number, Schmidt number and Porosity of the medium etc. The non-dimensional governing equations are solved analytically by using regular perturbation technique, and the graphs are plotted using MATLAB programming language. The mathematical expressions for fluid and particle velocity, fluid temperature, fluid concentration, skin friction for fluid and particle, flow flux for fluid and particle, Nusselt number, Sherwood number at the plates are evaluated and their nature of variations for different numerical values of physical parameters are shown graphically, discussed and conclusions are drawn

Effect of Induced Magnetic Field on MHD Flow Between Two Parallel Porous Plates at Constant Temperature Gradient in Presence of Inclined Magnetic Field

The paper studies effect of induced magnetic field on laminar convection flow of a viscous electrically conducting incompressible fluid between two parallel porous plates at constant temperature gradient in presence of a uniform inclined magnetic field. An angle (θ) is formed with the vertical line by applying a magnetic field in that direction and field is strong enough to induce another field along the line of flow. Using the proper similarity transformations, the flow equations are converted into ordinary differential equations, which are then numerically solved by using MATLAB's bvp4c solver. Plotting of the graphs allows one to examine the effects of several critical parameters such as Hartmann number, Darcy number, Magnetic Reynolds number, Prandtl number, and Field inclination on velocity field, induced magnetic field, temperature field at the plates. The acquired results demonstrate that the flow system is effectively influenced by the field inclination, the magnetic parameter, and the plate porosity. The rise in field inclination leads to an increase in magnetic drag force

Management of spasticity with intrathecal phenol injections: The past and the present

Introduction: Spasticity is increased, involuntary, velocity-dependent muscle tone that causes resistance to movement. Intrathecal injection of phenol is a form of treatment used in a very selective group of patients with spasticity. Aim: This study aims to highlight current evidence in the treatment of spasticity with intrathecal neurolytic phenol injections. Materials and Methods: A computer-based literature search was performed using MEDLINE, EMBASE, CINAHL, and the Cochrane Library using the following key words: intrathecal, phenol, spasticity, and pain. Results: The search identified 83 articles. Of 16 articles met the inclusion criteria of being specifically relating to the use of intrathecal phenol injections in spasticity. There was a lack of randomized controlled studies addressing intrathecal phenol injections in our search. Conclusions: Intrathecal phenol can be valuable for the treatment of spasticity when adapted for each individual, and used as part of an overall program that includes multidisciplinary team assessment and goal planning