Moreover, the cell viability, alkaline phosphatase (ALP) activity, and gene expression of type I collagen on these materials were evaluated. The data were statistically analyzed using one-way ANOVA with Tukey’s post hoc test. SLA-titanium showed the highest surface roughness and contact angle. The other three materials showed comparable surface roughness and contact angles. Micro- and nanoroughness were observed on the surface of SLA-titanium. UP zirconia and AM zirconia had similar surface morphologies. The cell viability, ALP activity, and gene expression of type I collagen on AM zirconia were comparable to or better than those on SLA-titanium. Our results indicate that AM zirconia is a promising material for zirconia dental implants.Zirconia ceramics have been widely used in dentistry. Herein, we assess the surface morphology, surface texture, and osteoblast response of additively manufactured zirconia and alumina-toughened zirconia (ATZ) in comparison with titanium. The surface roughness, contact angle, and surface microstructure of titanium sandblasted with large-grit alumina and subsequently acid-etched using 18% HCl and 49% H Zirconia ceramics have been widely used as alternatives to metals in dental restorations owing to their biocompatibility, mechanical properties, and aesthetics . NowadayA recent position paper reported that one-piece zirconia implants show comparable clinical prognoses to conventional titanium implants . CurrentIn a previous study, we clarified the basic properties of additively manufactured zirconia ceramics . Our resTherefore, this study aimed to assess the influence of surface morphology and surface texture on the osteoblast response of additively manufactured zirconia and ATZ in comparison with that of titanium. The null hypothesis was that the surface morphology, surface texture, and osteoblast response of additively manufactured zirconia and ATZ are similar to those of titanium.2SO4 at 60 °C for 30 min; (2) uniaxially pressed 3Y-TZP ; (3) additively manufactured zirconia : specimens were prepared using a stereolithography system  with a build direction of 0°; and (4) additively manufactured ATZ : specimens were prepared using a stereolithography system  with a build direction of 0°. Except for SLA-titanium, all specimens were used in the as-sintered conditions without any surface treatments. All specimens were prepared in the shape of a disk with a diameter of 10.8 mm and thickness of 1.2 mm (n = 27/group).The following four materials were investigated: (1) sandblast with large-grit and acid-etched titanium : the titanium specimen was polished with #320 abrasive paper and sandblasted with large-grit alumina (φ 250 µm), followed by acid-etching using 18% HCl and 49% Ha (arithmetic mean height) and Ra (arithmetic mean roughness) were calculated using ProfilmOnline software (https://www.profilmonline.com/ (accessed on 5 November 2022), Filmetrics, San Diego, CA, USA) with an 80 μm cutoff value.The surface roughness was examined via three-dimensional (3D) confocal laser microscopy . Ten regions (the effective field of view was 256 µm) were selected for each specimen. The average values of SThe contact angle was measured to assess the wettability of each specimen. A 2 µL droplet of distilled water was placed on the sample surface, and the contact angle was measured using an automatic contact angle meter .Microstructural analyses were conducted using scanning electron microscopy (SEM). Before the observation, the specimens were coated with osmium using an osmium coater . The coated specimens were observed using a field-emission-gun SEM  operated at 5 kV.2 incubator using an alpha modification of Eagle’s minimal essential medium . Fetal bovine serum (FBS) and 1% penicillin-streptomycin (PS) solution were added to this medium. The culture medium was replaced every 2 or 3 days. The four specimens  were cleaned with ethanol and distilled water and then dried. The specimens were sterilized in an autoclave  for 20 min at 121 °C and placed on a 24-well plate. MC3T3-E1 cells cultured in the aforementioned conditions were seeded at a density of 5 × 104 cells/mL on each disk. Cells were reacted using a Cell Proliferation Kit I -2,5-diphenyltetrazolium bromide (MTT); Roche, Sigma-Aldrich, St. Louis, MO, USA) after 1, 3, and 7 days. The standard solution was prepared and reacted for 30 min following the protocol provided by the manufacturer . The absorbance was measured using a spectrophotometer at 550 nm.Mouse osteoblast-like cells  were used to assess the cell viability of each specimen . Cells w2 incubator. α-MEM  with 10% FBS  and 1% PS solution (FUJIFILM Wako Shibayagi Corporation) was used and exchanged every 2 or 3 days. The four specimens were cleaned with 70% ethanol and distilled water and then dried. They were then placed in a 48-well plate. MC3T3-E1 cells cultured in the aforementioned conditions were seeded at a density of 5 × 104 cells/mL on each specimen. α-MEM with 10% FBS and 1% PS solution was supplemented with 50 μg/mL ascorbic acid (Sigma-Aldrich), 10 mM β-glycerophosphate (Sigma-Aldrich), and 1 µM dexamethasone (Sigma-Aldrich) and was used as a medium for inducing differentiation. The supernatant was removed, and the cells were washed with sterilized phosphate-buffered saline (PBS) before cell fixation. The cells were fixed using 4% paraformaldehyde (PFA) and then washed twice with PBS. The cells were frozen by cooling from room temperature (20–25 °C) to −20 °C in TritonX-100  and then melted by heating from −20 °C to room temperature (20–25 °C) in TritonX-100 three times. The alkaline phosphatase (ALP) activity and total amount of protein were quantified using LabAssay™ ALP (FUJIFILM Wako Shibayagi Corporation) and a BCA™ Protein Assay Kit (Thermo Fisher Scientific), respectively. The absorbance was measured at 405 and 562 nm and the ALP activity and amount of protein were analyzed.MC3T3-E1 cells (RIKEN BRC) were cultured at 37 °C in a 5% CO® StepOne™ (Thermo Fisher Scientific).MC3T3-E1 cells (RIKEN BRC) were cultured for 7 and 14 days in a manner similar to that described in a, Ra), contact angle, cell viability , ALP activity , and gene expression of type I collagen (at 7 and 14 days). All tests were performed at a significance level of α = 0.05 using a statistical software package .The results of the contact angle, cell viability, ALP activity, and real-time PCR tests were statistically analyzed using the Shapiro–Wilk test followed by either one-way analysis of variance (ANOVA) and Tukey’s post hoc test or the Kruskal–Wallis test and Dunn test. Moreover, the Pearson correlation coefficients were calculated to clarify the relationship between 11 factors: surface roughness , cell viability at 3 and 7 days, and ALP activity at 10 days. Sa and Ra were positively correlated with the cell viability at 3 and 7 days and ALP activity at 10 days. The cell viability at 1 day was positively correlated with the gene expression of RT-PCR at 7 days. The cell viabilities at 3 and 7 days were positively correlated with the ALP activity at 10 days. The gene expression of RT-PCR at 7 days was positively correlated with the gene expression of RT-PCR at 14 days. In contrast, the ALP activity at 7 days was negatively correlated with the contact angle, surface roughness (Sa and Ra) and cell viability at 3 and 7 days.A summary of the correlation analysis is presented in The results of the present study indicate that the surface morphologies and surface textures of the four materials investigated herein were different. Moreover, the cell viability of AM zirconia was comparable to that of SLA-titanium at 1, 3, and 7 days. However, the cell viability of AM ATZ was significantly lower than that of SLA-titanium at 3 and 7 days. The ALP activity of AM zirconia was significantly higher than that of UP zirconia. The gene expression of type I collagen on AM zirconia was highest at both 7 and 14 days. Thus, the null hypothesis ‘surface morphology, surface texture, and osteoblast response of additively manufactured zirconia and ATZ are similar to those of titanium’ was partially rejected.Currently, few studies have investigated the cell viability and osteoblast response of AM zirconia. SLA-titanium was selected as a control because it has excellent osteogenic ability . ZirconiIn the present study, an MTT assay was used to assess the cell viability. When MTT is introduced into the cells, dehydrogenase present in the mitochondria deoxidizes MTT into formazan dye. The amount of formazan dye is correlated with the cell population that shows metabolism, and the living cell population is measured using the MTT assay. The MC3T3-E1 cells used for cell culture on each specimen express ALP upon differentiation. The ALP activity was assessed because it is a differentiation marker of osteoblasts . In addia of SLA-titanium, measured by stereo-SEM, was 1.16 µm, whereas that of zirconia without surface treatment was 0.36 µm [a of SLA-titanium was 0.65 µm, whereas that of as-sintered AM zirconia was 0.54 µm [a of SLA-titanium was 1.15 µm [a of SLA-titanium was 1.2 µm [a of SLA-titanium in the present study was 2.23 µm, which is higher than those reported previously [a of AM zirconia in the present study was 0.27 µm, which is similar to those reported previously [a < 0.5 µm) and minimally rough surfaces (Sa = 0.5–1.0 µm) were weaker than those on titanium with rough surfaces. In contrast, titanium with moderately rough surfaces (Sa = 1–2 µm) showed a stronger bone response than that with rough surfaces (Sa > 2 µm). Further investigations are needed to clarify the influence of surface morphology of AM zirconia on the osteogenic ability of osteoblasts.In the present study, SLA-titanium presented the roughest surface. Strickstrock et al. reported that the S 0.36 µm . Kim et  0.54 µm . Buser e 1.15 µm , and Zhas 1.2 µm . The Sa eviously ,18,19,20eviously ,18. The eviously : the bonThe contact angle determines the wettability of materials. In general, a hydrophilic surface results in a better osteogenic ability than a hydrophobic surface . In the Jakovac et al. reported that 3Y-TZP grains had clear grain boundaries and a grain size of 1 µm or smaller . The SEMa, Ra) and contact angle of AM ATZ were lower than those of titanium, whereas they were comparable with those of AM zirconia. Because the surface roughness  and contact angles of AM zirconia and AM ATZ were comparable, we suggest that the difference in the composition of AM zirconia and AM ATZ  might aa was 2.23 µm, which is rougher than the moderately rough surface reported previously (Sa = 1–2 µm) [AM zirconia presented significantly higher ALP activity than UP zirconia at 10 and 14 days. Ito et al. compared the ALP activity of four differently treated zirconia materials: mirror-polished zirconia (MS), zirconia sandblasted with 50 µm alumina (SB 50), zirconia blasted with 150 µm alumina (SB 150), and zirconia blasted with 150 µm alumina and acid-etched with hydrofluoric acid (SB 150E). Their results showed that the ALP activities of SB 50, SB 150, and SB 150E were higher than that of MS at 7 days . Hirano  1–2 µm) .In the present study, no significant difference in the gene expression of type I collagen was observed between SLA-titanium and UP zirconia. However, the gene expression of type I collagen on AM zirconia was significantly higher than that on the other materials at 7 days and significantly higher than that on UP zirconia at 14 days. Ito et al. reported that there were no significant differences in the gene expression of type I collagen among MS, SB 50, SB 150, and SB 150E groups at 3, 7, and 14 days . Rohr eta, Ra) and contact angle. In general, a higher surface roughness results in a lower contact angle for hydrophilic materials, whereas a higher surface roughness results in a higher contact angle for hydrophobic materials [a, Ra) and contact angle. Nishimura et al. reported that a hydrophilic surface was more advantageous to initial cell attachment than a hydrophobic surface [The correlation analysis revealed a strong positive correlation between the surface roughness (Saterials . In acco surface . It is tIn this study, AM zirconia presented acceptable cell viability and gene expression of type I collagen. Zirconia ceramics show osteogenic ability not only in vitro but also in vivo. Uchida et al. reported that zirconia with tetragonal or monoclinic phases exhibited high apatite-forming ability in SBF . Li et aThe cell viability, ALP activity, and gene expression of type I collagen of AM zirconia were comparable to those of SLA-titanium. Thus, AM zirconia is considered suitable for applications in dental implants. In contrast, the cell viability of AM ATZ was lower than that of SLA-titanium. The results of the present study indicate that AM zirconia is a potential candidate for zirconia dental implants.


Dear readers,It is a distinct pleasure to once again highlight the significant contributions made to the International Brazilian Journal of Urology over the past year. Our journal has continued to expand its global reputation and broad readership over a tumultuous period of a global pandemic and diverse world conflicts as well as challenges. It is a true testament to the commitment of our journal and contributors to forge through in advancing science and surgical innovation during these times, with a direct consequence of this being an increasing recognition of our journal among the top tiered urological journals which is so very well depicted by our rapidly rising impact factor now benchmarked with many of the very best in our field.In making the selection of best videos of the year, several criteria have been employed including their surgical novelty and potential to improve patient care. These are clearly high bars set but truthfully I am thrilled to report that these challenging criteria have been achieved to a large extent by many of our published videos so all contributing authors of accepted videos over the past year are to be congratulated nevertheless there can only be a few select winners and on that note, I am pleased to announce that the first prize for best video of the year is awarded to the submission by Moschovas MC et al. entitled “Da Vinci SP radical prostatectomy: A multicentric collaboration and step-by-step techniques” published in the July-August issue (Vol 48(4):728-729) of our journal . The vidIn my closing remarks, I would like to thank our dedicated readers and submitting contributors in allowing our journal to achieving new echelons of global recognition within the urological community and we are very excited in envisioning the promising future ahead.Warmest regards and best wishes,


We describe preoperative considerations and imaging for successfully preparing for and performing video-assisted thoracoscopic surgery, robotic-assisted left upper lobectomy in the presence of a patent LITA to LAD bypass graft.An 85-year-old man with coronary artery disease (CAD) and history of left internal thoracic artery (LITA) to left anterior descending (LAD) bypass via left thoracotomy presented for evaluation of a left upper lobe pulmonary nodule. Differential diagnosis and therapeutic options were discussed, including stereotactic radiotherapy. After preoperative staging and medical evaluation, he was deemed an operative candidate. His forced expiratory volume at 1 second and diffusing capacity for carbon monoxide were 107% and 88% of predicted, respectively, and cardiac evaluation was unremarkable. The patient elected to undergo surgery. He consented to left video-assisted thoracoscopic surgery, robotic-assisted upper lobe wedge resection with completion lobectomy, and mediastinal lymph node dissection for malignancy confirmed intraoperatively. Risks of the operation and to the graft were discussed. When consenting to the operation, the patient verbally consented to the use of deidentified pictures and videos for academic purposes.Preoperatively, 3-dimensional (3D) reconstruction of his 2-dimensional (2D) computed tomography with contrast was performed using a DICOM viewer  and wereThe patient's chest tube was removed on postoperative day 1, and dual antiplatelet therapy was restarted. He was discharged home on postoperative day 2 without complication. His pathological stage was IA adenocarcinoma. He is doing well 6 months postoperatively with no sign of recurrence and a patent graft on his first surveillance scan.,Smoking is a risk factor for both lung cancer and CAD. Therefore, it is not surprising that patients with resectable lung cancers may have patent LITA to LAD bypass grafts. Previous LITA harvest and LAD anastomosis increase the complexity of the operation due to adhesion formation, putting the graft at risk.Although we do not use 3D reconstruction for every lung resection, this case is an example of an operation where more preoperative preparation is beneficial. We developed an imaging protocol at our institution allowing us to create 3D reconstructions from 2D images, specifically for delineation of vascular anatomy. A 256-slice computed tomography from the lung apices to the costophrenic angles is performed at deep inspiration. The region of interest is placed over the pulmonary trunk with a 60 Hounsfield unit threshold used to initiate the scan after a 6-second delay. Contrast is injected at 5 mL/sec for 100 mL with a retrospectively obtained electrocardiogram gated helical acquisition. This technique provides good separation of the pulmonary and systemic circulation. Using a DICOM viewer, we create 3D reconstructions to examine anatomy from all angles. Tissues of different densities can be added and subtracted as well to display their spatial relationships. The importance of 3D imaging in surgery has been described,This procedure has 2 principles: preserve the graft and achieve an R0 resection with appropriate lymph node staging for lung cancer. We were able to achieve the 2 principles of the operation while staying completely thoracoscopic because of our preoperative imaging and planning. We started dissection at the distal aspect of the graft, proceeding proximally. Our reconstruction clearly defined the distal extent of the graft, allowing us to anticipate its location intraoperatively. By starting with the least dense adhesions in a known area, and progressing to unknown, we successfully achieved the 2 principles. Our reconstruction made the unknown known by revealing the spatial relationship of the graft to other structures preoperatively, leading to anticipation of the graft's location and confident, safe dissection. Other adjuncts for safety can be considered for this procedure, such as groin prepping and cardiopulmonary bypass on standby.Preoperative imaging and planning are crucial for complex operations. Three-dimensional reconstructions are excellent complements to 2D imaging and should be considered for complex lung resections for surgeons at all stages of their career.


Background: Anterior cruciate ligament reconstruction (ACLR) using a generally columnar graft is considered the gold standard for treating anterior cruciate ligament ruptures, but such grafts cannot replicate the geometry and mechanical properties of the native anterior cruciate ligament.Purpose: To evaluate the effectiveness of an innovative hourglass-shaped graft versus a traditional columnar graft for restoring joint stability and graft force, while avoiding notch impingement following anterior cruciate ligament reconstruction.Methods: Finite element models of a human knee were developed to simulate ① An intact state, ② anterior cruciate ligament reconstruction using columnar grafts with different diameters (7.5–12 mm in 0.5 mm increments), ③ anterior cruciate ligament reconstruction using columnar grafts with different Young’s moduli  and ④ anterior cruciate ligament reconstruction using hourglass-shaped grafts with different Young’s moduli. The knee model was flexed to 30° and loaded with an anterior tibial load of 103 N, internal tibial moment of 7.5 Nm, and valgus tibial moment of 6.9 Nm. The risk of notch impingement, knee stability and graft forces were compared among the different groups.Results: This study found that columnar grafts could not simultaneously restore knee stability in different degree of freedoms (DOFs) and graft force to a level similar to that of the intact knee. The anterior tibial translation and graft force were restored to a near-normal condition when the internal tibial rotation was over-restrained and valgus tibial rotation was lax. A graft diameter of at least 10 mm was needed to restore knee stability and graft force to physiological levels, but such large grafts were found to be at high risk of notch impingement. In contrast, the hourglass-shaped graft was able to simultaneously restore both knee stability and graft force at knee flexion of 30° while also having a much lower risk of impingement.Conclusion: Under knee flexion angle of 30°, an hourglass-shaped graft was better able to restore joint stability and graft force to a near-physiological level than columnar grafts, while also reducing the risk of notch impingement. The anterior cruciate ligament (ACL) is important for normal functionality and movement of the knee joint. However, given the substantial multi-directional loads placed on the ACL, the ligament is prone to injury, particularly from non-contact athletic activities involving side-step cutting, heavy landing and rapid deceleration with the knee near full extension . In caseThe geometric features and material properties of common graft materials have been found to be significantly different to those of the native ACL. The graft size is often chosen regardless of the size of the native ACL, while the material properties are dependent on the source of the graft . The ACLAs such, using finite element modeling, this study aims to assess 1) whether the diameter and elasticity of columnar grafts can be tailored to fully restore knee joint stability and graft force while avoiding graft impingement, and 2) whether an hourglass-shaped graft or columnar graft can better replicate the function of the native ACL. Finite element analysis (FEA) was used in this study because it allows the variate to be repeatedly changed without damaging the sample and the variate can be strictly controlled to one factor when the other factors are maintained constant. These advantages allow for different diameters, material properties and shapes of grafts used for ACLR to be assessed individually in this study. The outcomes of this study may provide a scientific basis for improving the design of ACL grafts and improving the clinical outcome of ACL reconstruction.in situ force in the ACL. The element size was decreased until there was a negligible change in the in situ force in the ACL. The resulting element size was 1 mm. The model had a total of 659,251 elements. The material properties of the tissues were defined according to previous literature . Ligaments were defined as isotropic hyperelastic tissues using strain energy functions. The Veronda-Westmann function was used to define the properties of the ACL and PCL , while the Mooney-Rivlin material model was used to define the mechanical properties of the MCL and LCL. The coefficients of the LCL were assumed to be identical to those of the MCL (C1 = 30.1 MPa and C2 = −27.1 MPa). The model was validated using data from cadaveric experiments in terms of joint kinematics and ACL forces under an anterior tibial load, valgus tibial moment and internal tibial moment. The model had a calculation accuracy of 0.1 mm for anterior tibial translation, 1 This study used a previously validated finite element (FE) model , 3A for terature . Bones (The following simulation groups were included in this study: 1) Intact state (group I); 2) ACL reconstruction (ACLR) using a columnar graft with different graft diameters (group II); 3) ACLR using a columnar graft with different graft elasticities (group III); 4) ACLR using an hourglass-shaped graft resembling the dimensions of the native ACL in terms of the cross-sectional area (CSA) of its bone insertion sites and isthmus (group IV).Using the software Abaqus/CAE 6.14–2 , all simulation groups were assigned the same boundary and loading conditions . First, moments) , thus thmoments) .in situ forces in the ACL and grafts were also obtained to evaluate the restoration of normal functionality. A lower force borne by the graft in comparison to the native ACL would indicate insufficient restoration, which may produce greater loading in other joint tissues and increase the risk of secondary damage.Joint stability under the above loading conditions were recorded to evaluate the stability and stiffness of the knee, including the anterior tibial translation (ATT), internal tibial rotation (ITR) and valgus tibial rotation (VTR). Greater knee displacement than the intact state indicates knee instability in the corresponding DOFs, and less knee movement may indicate over-restraint of the joint. The min)  against the minimum width of the space between the femoral notch and the tibial plateau (Lmin) . For theThe results from the ACLR groups  were compared with the intact group (group I) to evaluate the effectiveness of each technique at restoring graft and knee function.This study simulated anatomical single bundle ACL reconstruction . The cenectively . The colectively . One endFor the simulation group II, different graft diameters were evaluated, but the material properties were constant across all models (Young’s moduli = 129.4 MPa), thus to simulate different diameters of a certain type of graft tendon . Previous studies reported a wide variation in the elasticity of commonly used materials for ACL reconstruction . For gro2, respectively). The normal lines of the proximal and distal sections were parallel to the tunnel axes in group II and the normal line of the isthmus section was parallel to the cross-sectional plane of the native ACL isthmus.Group IV used an hourglass-shaped graft to replace the native ACL in the knee joint . The graImP for the columnar and hourglass-shaped grafts are shown in ImP. Grafts with data points lying at and above the red dotted line (columnar grafts with a diameter of 10–12 mm) could not be adequately accommodated within the femoral intercondylar notch at full knee extension, and thus were at higher risk of impingement (Rimp = 100%–120%). Grafts with data points below the red dotted line  were at lower risk of notch impingement (Rimp = 75%–95%), and the risk decreased as the diameter was reduced. The hourglass-shaped graft had a lower risk of notch impingement than all of the columnar grafts (Rimp = 74%).The minimum height between the femoral notch and tibial plateau was measured as 10 mm. The corresponding values of Rin situ force in the graft (128 N vs. 111 N). However, internal tibial rotation (ITR) was consistent with the intact knee  at 6 months after ACL repair, with a higher ACL stiffness producing less cartilage damage  The Young’s moduli of the grafts were obtained from literature, but the reported properties of grafts in literature can vary considerably and so the moduli used in this study may be different from those used in clinical practice. As shown by this study, larger graft elasticity resulted in lower knee laxity and greater graft force. This study suggests that the mechanical properties of ACL grafts should be carefully evaluated and selected for ACLR to adequately restore knee functionality. 2) All grafts were considered to have isotropic material properties. However, in clinical practice, the graft properties is anisotropic and can undergo minor changes during implantation due to its viscoelasticity. Nevertheless, the main function of the ACL is to bear tensile forces and the loading conditions used in this study primarily act to tension the ACL and grafts. Assigning isotropic properties to the ligaments should have little effect on the main findings of this study. The models in this study did not consider graft viscoelasticity, which may result in a stiffer joint than a physical knee. As such, future studies may further explore the effect of viscoelasticity on graft functionality after ACLR. 3) The internal tibial rotation (ITR) may be over-constrained in this FE model in comparison to the native ACL because the longitudinal fibers of the ligament were not considered, and thus the rotations of fibers could not be simulated. This may result in a lower simulated ITR of the knee. 4) Only a static loading condition was considered. Effectiveness of using the hourglass-shaped graft may vary in different knee flexions and different loadings such as dynamic loadings representing different daily activities. Future studies should further evaluate its effectiveness under more complex loading environments. 5) Different fixation techniques may lead to variation in the stiffness of the bone-graft-bone complex. In the current study, a good fixation between the graft and bone tunnel was assumed, which permits no relative motion between them. Such a completely rigid fixation neglected the graft sliding along the longitudinal axis of the bone tunnels and may result in a lower knee laxity after ACLR than the real situation.In the current clinical practice, auto-grafts are often more convenient to use and can reduce the risk of immune reactions, but they can also compromise knee functionality, as shown in the current study. The currently used graft size is usually depending on the used tendon. We thus look forward to future developments of advanced biotechniques for better processing allografts and biomaterials to produce more effective artificial grafts for better restoring the joint functionality.At the knee flexion angle of 30°, the hourglass-shaped graft was better able to restore joint stability and graft force after ACLR than columnar grafts. The hourglass graft might also be beneficial for reducing the risk of impingement on the femoral notch. The findings of this study provide information on designing and choosing suitable grafts depending on the conditions of the native knee, and thus may improve the clinical outcome of ACLR.This study provides innovative concepts for designing and choosing suitable grafts for ACLR, especially when using allografts or artificial grafts, and thus may improve the clinical outcome of ACLR.


Changes in CAVI from 0 min to 240 min were significantly correlated with water removal rate (WRR) . Changes in CAVI at each measurement point were negatively correlated with ΔBP . Whereas one patient exhibited a simultaneous decrease in BP and CAVI during the initial 60 min of HD. Arterial stiffness monitored with CAVI generally increased during HD. CAVI elevation is associated with decreased WWR and BP. An increase in CAVI during HD may reflect the contraction of smooth muscle cells and play an important role in BP maintenance. Hence, measuring CAVI during HD may distinguish the cause of BP changes.During hemodialysis (HD), blood pressure (BP) changes are frequently observed. However, the mechanism of BP changes during HD has not been fully clarified. The cardio–ankle vascular index (CAVI) reflects the arterial stiffness of the arterial tree from the origin of the aorta to the ankle independent from BP during measurement. Additionally, CAVI reflects functional stiffness in addition to structural stiffness. We aimed to clarify the role of CAVI in regulating the BP system during HD. We included 10 patients undergoing 4-hour HD . Changes in the CAVI and various hemodynamic parameters were evaluated during each session. During HD, BP decreased and CAVI significantly increased (CAVI, median [interquartile range]; 9.1 [8.4–9.8] [0 min] to 9.6 [9.2–10.2] [240 min],  Blood pressure (BP) changes can occur during hemodialysis (HD) and hypotension attack and is associated with severe clinical symptoms such as fainting, discomfort, and sweating. Intra-dialytic hypotension occurs in 10%–12% of HD cases and is related to poor prognosis . The chaArterial stiffness consists of structural and functional stiffness. The former mainly reflects arteriosclerosis and vascular aging. The latter reflects arterial smooth muscle contraction . As an iß theory  was developed as a BP-independent arterial stiffness index by applying the stiffness parameter ß theory . The CAVß theory , and funß theory . FunctioIn this study, we measured CAVI during HD to clarify the role of CAVI in maintaining systemic circulation.We enrolled 10 patients who underwent a 4-hour HD therapy at Mihama Hospital between March 2015 and May 2015 for a total of 57 HD sessions . Patients with persistent atrial fibrillation, peripheral arterial disease with ankle–brachial index <0.9, and severe aortic valvular heart disease were excluded from this study.We analyzed the systolic BP (SBP), diastolic BP (DBP), heart rate (HR), heart–ankle PWV (haPWV), CAVI, and stroke volume (SV) during HD. The BP, HR, haPWV, and CAVI were measured using VaSela VS-1500  after 10 min of rest in the supine position. Simultaneously, SV was non-invasively measured using an impedance cardiac output meter . Systemic vascular resistance (SVR) was calculated as the ratio of mean BP to cardiac output (CO).0–240 min, ΔSBP0–240 min, ΔDBP0–240 min, ΔHR0–240 min, ΔSV0–240 min, ΔCO0–240 min, and ΔSVR0–240 min) and water removal rate (WRR), which was defined as the percentage of WRV per body weight before HD, were analyzed. To examine the relationship between CAVI and other parameters at each measurement point (MP), the correlation between the changes in CAVI at each MP (ΔCAVIeach MP) and the changes in other parameters at the same time  were also analyzed.To evaluate the intra-dialytic changes in arterial stiffness and hemodynamics, each parameter was measured at the following points during each HD session: before HD (0 min), 30 min, 90 min, 150, 210, and 240 min, and after blood return. To examine the relationship between changes in CAVI or various hemodynamic parameters and water removal volume (WRV), the correlation between changes in CAVI or other parameters from 0 min to 240 min  , as appropriate. Categorical variables are expressed as percentages. Hemodynamic parameters, including CAVI, are expressed as median (IQR). Comparisons of hemodynamic parameters during HD were performed using the Friedman test and the , Japan)  and JMP Informed consent was obtained from all patients. This study was approved by the ethics committee of Toho University Sakura Medical Center (S18019) and Mihama Hospital (17-010) and was performed in accordance with the latest version of the tenets of the Declaration of Helsinki.A total of 10 patients undergoing HD were enrolled in this study. All patients received 4-hour HD for 3 times per week; 9 patients who had 6 HD sessions and 1 patient who had 3 HD sessions were enrolled in the study, thus providing a total of 57 HD sessions for analysis.ß-blocker, 30%; and hypoglycemic agent, 10%). Mean total WRV per single HD session was 2992.6 ± 564.2 mL, and mean WRR was 5.5% ± 1.3%.0–240 min or ΔBP0–240 min and WRR. ΔCAVI0–240 min was significantly correlated with WRR .each MP significantly correlated with ΔSBPeach MP and ΔDBPeach MP . ΔCAVIeach MP was positively correlated with ΔHReach MP and was negatively correlated with ΔSVReach MP .An 85-year-old man exhibited a decrease in BP at 60 min during HD, as shown in p = 0.25; DBP: r = 0.15, p = 0.31; In present study, we observed changes in hemodynamic parameters and arterial stiffness monitored with CAVI during HD, and the relationship between hemodynamic parameters and CAVI was evaluated. The SBP and DBP started to decrease at 30 min; this decrease continued until 240 min and then increased slightly after blood return, as shown in Conversely, CAVI gradually increased from 30 min, and the increase was significant at 150 min to 240 min. The contradictory changes between BP and CAVI were also confirmed by significant correlations between ΔSBP and ΔDBP and ΔCAVI at each MP, as shown in via the stimulation of the sympathetic autonomic nervous system by hypotension. However, more studies are required to understand this further.Reportedly, CAVI reflects functional stiffness in addition to structural stiffness of the arterial tree . The adrvia peripheral artery resistance  that were measured CAVI at same time points. Second, although the mechanism of increased CAVI was presumed to be due to the activation of the sympathetic nervous system, the precise mechanism has not been verified. Third, the number of cases in which CAVI decreased during HD was small, and we were not able to show mechanisms for the decrease in CAVI. Therefore, further studies with a large number of patients and on precise mechanism are needed to clarify.


Ge) of 60.1, 72.4, and 70.5 °C at batter humidity and gelatinization enthalpies (ΔHGe) of 9.2, 15, and 9.1 J/gdry starch. Due to the effect of the salt and carrot, the corresponding wholemeal batter had TGe of 64.2, 74.1, and 72.4 °C and ΔHGe of 10.5, 15.3, and 10.9 J/gdry starch. Acidified batters at pH 4 saw their TGe decrease, and their enthalpies increase compared to the controls. The calorimetric study of model mixtures revealed three different evolutions of ΔHGe as a function of pH, explained by the isoelectric behavior of flours and/or the attack of starch by acetic acid. (4) Conclusions: These results could be useful for adapting the cooking step of the acid batter in order to produce alternative snacks.(1) Background: Adding white vinegar to the batter of a sponge cake without biological fermentation requires the effects of acidification on the batter to be checked, in particular concerning batter-to-crumb transition. (2) Methods: µDSC analyses were carried out on three batters formulated from flour, colza oil, salt, carrot, and water with or without the addition of white vinegar. (3) Results: Wheat, chickpea, and quinoa starches had gelatinization temperatures (T Almost half 47%) of French people have an aperitif at least once a week . With ar7% of FreIn the context of our study, the use of an alternative process for manufacturing snacks, obtained by drying a sponge cake , does no2SO4, but under lintnerization conditions [To our knowledge, acetic acid has been studied on wheat, potato, rice, and tapioca starch ,16,17. Wnditions ,19,20. Onditions , or formnditions .One of the primary objectives of this invention is to produce high-fiber snacks using so-called “ugly” vegetables deemed unsuitable for sale, the batter studied contains a high content of vegetable fibers. For these snacks made using an innovative process, it is important to know the energy needed to allow complete gelatinization of the starch system in the batter during cooking. The objective of this work is therefore to study and compare the changes in gelatinization behavior under the influence of acetic acid of different starches , present in acidified vegetable sponge cakes.W)  was supplied by the Giraudineau mill . Desi variety organic chickpea flour  was provided by Qualisol . Quinoa flour (FQ)  was obtained from seeds of Blond Berry Quinoa purchased from SAS Berry Graines . The unshelled seeds were crushed with a Retsch ZM200 brand ultracentrifugal grinder  consisting of a 12-tooth rotor and a 0.2 mm mesh sieve. The carrot puree (C) (moisture 92.7%) was provided by Clément Faugier ETS  in frozen form. The puree pebbles were put in a cold room at 4 °C for 48 h before being used to defrost them. Rapeseed oil (O) , fine table salt (Sa), and white vinegar  were bought in supermarkets . The water (W) was millipore water, bubbled under N2 before use to overcome oxidation phenomena.Organic T45 wheat flour  primary model media. These simplified mixtures were made for two humidity values: the reference value (65%) and excess water (80%).The reference model mixtures were flour and water  at room temperature.For each flour, a range of mixtures have been made in the presence of vinegar and water (55 mg of flour for 100 g of plasticizer) to reach 4 different pH values from 3 to 6. For each mixture, zeta potential has been measured by electrophoretic light scattering with a Zetasizer analyser . After equilibration during 20 min at 20 °C. The operation has been made on 5 samples per mixtureGe) and the gelatinization enthalpy (ΔHGe) were determined. In addition, the partial melting enthalpy was calculated from the start of the endotherm (in 1 °C increments) to plot the curve representing the cumulative enthalpy values as a function of temperature.The gelatinization properties of the starches were studied for all the mixtures with a µDSC 7 microcalorimeter . An empty cell was used as a reference. 300 to 500 mg of the sample were placed in a sealed µDSC Hastelloy capsule for thermal analysis. After equilibration at a temperature of 10 °C and maintaining at this temperature for 10 min, a rise from 10 to 120 °C at a rate of 1 °C/minute was carried out. The thermograms obtained were normalized in J/g of dry starch for analysis. The gelatinization peak temperature , on the other hand interesting features . Indeed, they had already given satisfactory results on dough rheology, bread texture and sensory analysis ,24,25.Ge equal to 59.6 +/− 0.2 °C which was close to the results of Sopade et al. (60.3 °C) [Ge was 9.7 +/− 0.4 J/gdry starch (9.2 +/− 0.2 J/gdry starch for Sopade).Wheat flour with excess water (80%) showed a gelatinization temperature T60.3 °C) . The meaGe = 70.4 °C +/− 0.4 °C and ΔHGe = 12.6 J/gdry starch. In the literature, the authors mentioned slightly higher TGe gelatinization temperatures (70.6 to 73.3 °C) and much lower enthalpies (<5 J/g flour) [dry starch. These results were different from those mentioned in the literature [For chickpea flour, the gelatinization temperature and enthalpy found were Tg flour) ,28,29. Hterature ,31, withterature , and theGe gelatinization temperatures of chickpea and quinoa flour were shifted to higher temperatures 72.4 +/− 0.1 °C and 70.5 +/− 0.1 °C, respectively, whereas they were stable for wheat starch when the water content decreased (65%). A more or less marked increase in TGe when the water content decreases has been observed for mixtures with chickpea flour [The Tea flour  and alsoea flour , chestnuea flour , and ricea flour . MoreoveBatters FOSaW where F represented the flour (wheat or chickpea or quinoa), O the fat, S the salt, and W the total water of the system, had a higher gelatinization temperature .35W65 primary systems. This can be explained by the fact that the salt concentrations in our systems were very low (1.5 to 2% of the dry weight of the starch), which reduced its effect. Chiotelli and al [This slight increase in the gelatinization temperature was linked to the presence of salt which competed with the starch for access to water. This competitive hydration resulted in less availability of water for starch gelatinization. D’Appolonia in 1972 and Spies and Hoseney in 1982 attributed the increase in gelatinization temperature to the solute’s ability to limit the amount of water available to starch, i.e., to reduce the water chemistry potential ,37. Howei and al  observedFor the 3 complete batters FOSaCW where C represented the carrot, the differential enthalpy analysis study  showed tIn the literature, fibers are added in the form of soluble or insoluble fibers. It was shown that insoluble or partially soluble fiber provided major effects on gelatinization (TGe decrease and ΔH increase). For example, Santos et al.  have stuWe agreed with the literature but the water content of our sponge cakes being higher, the effect was less visible and for an equivalent water content our fiber content was lower.The study also focused on the impact of the acidification of a vegetable sponge cake batter with white vinegar on the thermal properties of the mixture. In order to determine the quantity of acetic acid to be used in the mixtures to reach a targeted pH of 4, a pH determination analysis was carried out on the batter with or without the presence of carrots.Ge but the opposite effect for the gelatinization enthalpy and they suggested that the crystalline structure of the starch molecules inside the granules, was affected by the acids and hence less energy required to melt the crystalline structure. Likewise, Ohishi and collaborators [A differential enthalpy analysis study was then conducted on FOSaCP batter to observe the hydrothermal properties of acidified batter. Gelatinization temperatures and enthalpies were shown in orange in borators  showed bborators  also repborators , for a pborators .Ge moved from 58.7 °C to 70.3 °C after 10.5 h [Ge moved from 132.8 °C to 139.6 °C [2SO4 , chickp139.6 °C ) or quin 86.4 °C ). Velasq 86.4 °C ,20. Thes 86.4 °C .The whole of this work did not lead to the same conclusions, and the effects of acid on starch were sometimes contradictory between several works. The authors’ hypotheses expressed that gelatinization enthalpy value, related to the energy required to break down starch organization, could be dependent on crystalline organization, or water intake in amorphous area. It was difficult to compare all the results for two reasons. On the one hand, authors studied starch and not a whole batter and it was shown that ingredient addition could affect starch environment and might interact with acetic acid. Furthermore, the results have been obtained in different pH conditions and pH value could be an important factor to consider. For example, the impact of acetic acid on gelatinization could be related to the electrical potential of flours. Therefore, a study of F20P80 model systems was investigated as a function of pH by µDSC.Ge was stable up to a threshold pH , then dropped when the pH decreased. w35P65 standard mixtures was not influenced by the presence of acetic acid, whereas for the FCP35P65 standard mixtures, the evolution of ΔHGe followed a “bell-shaped” curve, presenting a maximum enthalpy of 17.6 +/− 1.3 J/gdry starch at pH 3.8. Finally, for the FQ35P65 mixtures, the enthalpy ΔHGe increased significantly from 8.4 +/− 0.3 to 11.7 +/− 0.9 J/gdry starch as soon as acetic acid was added, then stabilized.For the 3 flours, the Tw, FCP, and FQ) were 5.8, 3.7, and 3.0, respectively. The increase in gelatinization enthalpy of FCP flour may be related to the electrical point of chickpea starch. At pHi, the overall charge from surface proteins to starch was zero. If pH < pI, the overall charge was positive. If pH > pI, the overall charge was negative. It was around pH 4 (3.7) that the isoelectric potential of chickpea flour canceled out; this result was also shown by Emami in 2007 [The isoelectric points (pI) of the different flours were determined by measuring the zeta potential. Indeed, the zeta potential changes from positive to negative values when the pH increases and the pH at which the zeta potential is zero is the isoelectric point. The isoelectric points of the 3 flours  into the starch granule, the curves of cumulative enthalpies were calculated and reported as a function of temperature. The partial gelatinization enthalpy curves for the three starches studied are shown in 35W65 mixtures  [At free pH,  the shapes of the curves illustrated for the Fmixtures  were qui., 2000) . As for ., 2000)  showed t., 2000) , and thew35P65 and FCP35P65 primary systems (Although at pH 4 (P = water + acetic acid), the penetration rate of the plasticizer remained identical for the F systems , a slighw35P65 mixture but increased sharply for the FCP35P65 and FQ35P65 mixtures. Our results showed that two different mechanisms were at play to explain the increase in gelatinization enthalpy of the FCP35P65 and FQ35P65 mixtures. Indeed, for chickpea flour, at pH 4, the passage of the isoelectric point led to the aggregation of proteins creating a steric barrier to the plasticizer which caused an increase in enthalpy. For quinoa flour, the considerable increase in the total gelatinization enthalpy suggested a better organization of the ordered regions of the starch, linked to an attack of the amorphous regions by acetic acid. Indeed, according to Donovan’s [The total gelatinization enthalpy (ΔH) in the presence of acetic acid remained almost constant for the Fonovan’s  theory, In this study, we followed the changes in the gelatinization behavior of three starches  under the influence of acetic acid in vegetable sponge cake in order to obtain new snacks.The addition of vegetable fibers such as carrots to the sponge cake batter causes a very slight increase in the gelatinization temperature. The quantity of free water available, at this water content, is largely sufficient to allow complete gelatinization without modifying the cooking temperature. On the other hand, the acidification of the sponge cake with white vinegar to reach a pH of 4 causes a modification of its thermal properties. Indeed, the gelatinization of the starch appears at a lower temperature in the sponge cake batter formulated with chickpea and quinoa flour than the starch in the corresponding batter without vinegar. However, it is almost identical to the sponge cake made with wheat flour. This work will allow adjusting the microwave cooking parameters (time and power) to obtain complete gelatinization of these acidified vegetable sponge cakes.Moreover, it is interesting to observe that the mechanisms of action of acetic acid on starch depend on the type of flour used. Indeed, two mechanisms of action of acetic acid on starch, one direct and the other indirect, have been demonstrated: (1) The acetic acid contained in vinegar acts directly on the starch of quinoa itself at low concentration with a marked increase in the speed of the plasticizer penetration into the granule. (2) For chickpea starch, acetic acid acts indirectly on its gelatinization by modifying the zeta potential of the other flour components, which probably causes steric hindrance for the supply of the plasticizer in the starch granules.


Posterior open-wedge osteotomy and glenoid reconstruction using a J-shaped iliac crest bone graft showed promising clinical results for the treatment of posterior instability with excessive glenoid retroversion and posteroinferior glenoid deficiency.To evaluate the biomechanical performance of the posterior J-shaped graft to restore glenoid retroversion and posteroinferior deficiency in a cadaveric shoulder instability model.Controlled laboratory study.A posterior glenoid open-wedge osteotomy was performed in 6 fresh-frozen shoulders, allowing the glenoid retroversion to be set at 0°, 10°, and 20°. At each of these 3 preset angles of glenoid retroversion, the following conditions were simulated: (1) intact joint, (2) posterior Bankart lesion, (3) 20% posteroinferior glenoid deficiency, and (4) posterior J-shaped graft (at 0° of retroversion). With the humerus in the Jerk position , stability was evaluated by measuring posterior humeral head (HH) translation (in mm) and peak translational force (in N) to translate the HH over 25% of the glenoid width. Glenohumeral contact patterns were measured using pressure-sensitive sensors. Fixation of the posterior J-graft was analyzed by recording graft micromovements during 3000 cycles of 5-mm anteroposterior HH translations.P < .05). There was no significant difference in joint stability comparing the posterior J-graft with an intact joint at 0° of retroversion. The posterior J-graft restored mean contact area and contact pressure comparable with that of the intact condition with 0° of retroversion . The mean total graft displacement after 3000 cycles of loading was 43 ± 84 µm, and the mean maximal mediolateral graft bending was 508 ± 488 µm.Reconstructing the glenoid with a posterior J-graft to 0° of retroversion significantly increased stability compared with a posterior Bankart lesion and posteroinferior glenoid deficiency in all 3 preset degrees of retroversion (Biomechanical analysis of the posterior J-graft demonstrated reliable restoration of initial glenohumeral joint stability, normalization of contact patterns comparable with that of an intact shoulder joint with neutral retroversion, and secure initial graft fixation in the cadaveric model.This study confirms that the posterior J-graft can restore stability and glenohumeral loading conditions comparable with those of an intact shoulder. Although posterior bone-block procedures can increase the width of the posteroinferior glenoid joint surface,41 excessive glenoid retroversion remains unchanged. This alteration in articular alignment is a known risk for posterior instability as well as persistent instability after posterior shoulder stabilization procedures.27 Correcting glenoid retroversion therefore has theoretical advantages in restoring joint stability, and using an opening-wedge osteotomy to do so was first described by Scott.35 Although this procedure has evolved since the original description, recent long-term results of this procedure revealed that shoulder stability was not reliably restored, and the procedure was not able to recenter the joint or prevent progression of osteoarthritis.39Operative management of posterior shoulder instability with excessive glenoid retroversion and posteroinferior glenoid deficiency is challenging and includes soft tissue procedures, posterior bone block, or glenoid osteotomy.9 The preliminary short-term results of a small group of patients with atraumatic posterior shoulder instability associated with excessive glenoid retroversion and posteroinferior glenoid deficiency showed that the posterior J-graft is able to reconstruct posteroinferior glenoid morphology, correct glenoid retroversion, and improve posterior shoulder instability.12 However, no biomechanical data on this technique are available.A recent novel surgical technique was introduced that combines a posterior opening-wedge osteotomy with glenoid concavity reconstruction using an implant-free, J-shaped autograft iliac crest bone graft.The purpose of this study was to evaluate the (1) stabilizing effect, (2) glenohumeral contact patterns, and (3) initial graft fixation under cyclic loading, using the posterior J-graft to restore glenoid retroversion and posteroinferior deficiency in a cadaveric shoulder model. It was hypothesized that the posterior J-graft would restore stability, which was defined as the amount of posterior displacement when a posteriorly directed force of 20 N was applied as well as the force that was needed to resist posterior translation over 25% of the glenoid width, and glenohumeral contact patterns, which were assessed by using pressure-sensitive pads to measure contact area and contact pressure throughout posterior humeral head (HH) translation, to that of a native glenohumeral joint with secure initial graft fixation.Ethical approval was obtained for this controlled laboratory study.10 All specimens were thawed for 24 hours at room temperature. All the soft tissues were dissected off the scapula and humerus, leaving only the capsule and labrum intact. The anterior capsule was vented as described previously.23 The humeral shafts were cut 2 cm distal to the deltoid tuberosity. The scapulae were potted with polymethylmethacrylate in a custom box with the glenoid surface parallel to the floor . The humeri were fixed with multiple screws into a customized cylinder. Specimens were kept moist with phosphate-buffered saline to prevent dehydration during specimen preparation, surgical repair, and testing.Six fresh-frozen cadaveric shoulders and hemipelvises for iliac crest bone graft harvest from MedCure were used for this study. The mean age at death was 52.8 ± 9.2 years, and there were 3 female and 3 male donors. All specimens were inspected visually and by computed tomography (CT) scan for soft tissue or bone defects, or signs of moderate to advanced glenohumeral arthritis, and deemed to have no signs of glenohumeral arthritis or macroscopic rotator cuff tears. Further CT scan evaluation included native glenoid retroversion and bone mineral density assessment in a 1 × 1–cm area of the posterior glenoid neck.23 3 different angles were obtained through the external fixator: 0°, 10°, and 20° of glenoid retroversion  with a range of ±0.5°.Intact joint, neutral retroversionIntact joint, 10° of retroversionIntact joint, 20° of retroversionPosterior Bankart lesion, neutral retroversionPosterior Bankart lesion, 10° of retroversionPosterior Bankart lesion, 20° of retroversion20% posteroinferior glenoid deficiency, neutral retroversion20% posteroinferior glenoid deficiency, 10° of retroversion20% posteroinferior glenoid deficiency, 20° of retroversionPosterior J-graft creating neutral retroversion12 The exact dimension of the osteotomy was calculated using CT scan analysis based on the Pico method.29 The MicroScribe digitizer was used to mark the osteotomy, which was then performed with a chisel along a line parallel to the long axis of the glenoid.42The posterior Bankart lesion was created through the anterior capsular window. The labrum was sharply detached from 6- to 9-o’clock. Next, a longitudinal posterior capsulotomy was performed and the posteroinferior glenoid rim exposed. An osteotomy simulating 20% posteroinferior glenoid deficiency was chosen based on the preoperative glenoid morphology of patients undergoing the posterior J-graft.12: a bicortical iliac crest bone graft including the crest and inner table was harvested and molded into a J-shaped graft using the oscillating saw. The J-graft was used to correct to 0° of retroversion, and the mean width at the widest point of the long leg of the J-graft was 4.7 ± 0.7 mm  performed all surgeries. Harvest, preparation, and implantation of the J-shaped iliac crest bone grafts were conducted according to the original surgical technique± 0.7 mm .The J-graft was inserted into the osteotomy site and impacted into place with a press fit . The pos42 The humerus was mounted in the Jerk test position,28 which was defined as neutral adduction, 60° of glenohumeral anteflexion, and 60° of internal rotation.40 The scapular box was mounted onto a vertical linear bearing translator and lever arm system on top of the 2 translation plates that permitted anteroposterior and superoinferior translations . All specimens were preconditioned for 10 cycles with a cyclic force of −10 to 10 N relative to the applied baseline compressive force.23 The actual stability testing was composed of 2 different protocols: (A) a force-controlled protocol analyzing the amount of posterior HH translation (in mm) with a posteriorly directed force of 20 N at a rate of 1 N/s and (B) a displacement-controlled protocol analyzing the peak translational force needed to translate the HH posteriorly over 25% of the glenoid width at a rate of 3.0 mm/s. The amplitude of force applied in protocol A was chosen according to a similar biomechanical study.23 The amplitude of displacement applied in protocol B was chosen according to multiple biomechanical shoulder instability studies.43 Forces observed during testing were recorded by a load cell  of the MTS. All tests were performed with the humerus in the Jerk test position and at each of the 3 glenoid retroversion angles  for the following glenoid conditions: (1) intact joint, (2) posterior Bankart lesion, and (3) 20% posteroinferior glenoid deficiency. Then all tests were performed after posterior J-graft positioning correcting to 0° of glenoid retroversion. Testing was repeated 3 times, and mean values were recorded.A compressive load of 22 N was applied perpendicular to the glenoid through the vertical linear bearing translator and lever arm system, allowing the HH to find its neutral position in the glenoid concavity.42 The 0.1 mm–thick dynamic pressure-sensitive pads  were used.42 All sensors were precalibrated according to the manufacturer’s guidelines. The sensor was positioned between the HH and glenoid concavity and marked to ensure correct positioning throughout testing.33The same shoulder-testing system as outlined above was used for measuring glenohumeral contact patterns.After finding the neutral position of the HH in the glenoid concavity as described above, the same force-controlled protocol with a posteriorly directed force of 20 N was used for analyzing glenohumeral contact patterns. The pressure-sensitive pads measured contact area and contact pressure throughout translation. Again, all tests were performed with the humerus in the Jerk test position and at each of the 3 glenoid retroversion angles  for the intact, pathological, and repaired (at 0°) conditions as outlined previously.42 As described in a similar biomechanical study on cyclic graft loading, the compressive force was increased to 50 N.33 Again, the compressive load allowed the HH to find its neutral position within the glenoid concavity, which defined the reference-neutral position.33 With the humerus in the Jerk test position, a 5-mm posteroanterior translation cyclic loading protocol at a rate of 4.0 mm/s was selected according to a similar study.33 The reconstructed glenoid and posterior J-graft were loaded for a total of 3000 cycles. During cyclic loading, graft displacement in the posterior direction  and mediolateral bending motions were recorded using 2 high-resolution (±1.5 µm precision), linear differential variable reluctance transducer strain gauges . These 2 strain gauges were placed in line with the long leg of the posterior J-graft and in the mediolateral direction, respectively.33Cyclic loading was also conducted with the same custom shoulder-testing system.P < .05 with use of Bonferroni (repeated-measures ANOVA) and Dunn-Bonferroni (Friedman ANOVA) adjustments; all P values were 2-tailed.Distribution of the data was assessed with the Shapiro-Wilk test. All conditions in each of the 3 different angles of glenoid retroversion for stability testing and assessment of glenohumeral contact pattern were compared using the repeated-measures analysis of variance  and Friedman ANOVA (nonparametric data). Significance was set as 23An a priori power analysis revealed that for a significance level of .05 (type I error), a sample size of 6 specimens was sufficient to provide a desired power of 80% to detect a difference of >5 mm of posterior HH translation with a similar force-controlled testing protocol.Mean native glenoid retroversion was 2.6° , and bone mineral density was 162 ± 31 Hounsfield units.P = .339; peak translational force: 24 vs 25 N, P = .597). The posterior J-graft showed significantly less posterior HH translation compared with the intact condition with 20° of retroversion   .Appendix file (available in the online version of the article).Detailed information of the results revealed during the 2 instability testing protocols can be found in the 2; P = .980).The mean contact area significantly decreased with a posterior Bankart lesion and posteroinferior glenoid deficiency, respectively . The posP = .203).Similarly, mean contact pressure significantly increased with a posterior Bankart lesion and posteroinferior glenoid deficiency, respectively . The posThe mean total graft displacement in the posterior direction  after 3000 cycles of posteroanterior loading was 43 ± 84 µm. The mean maximal mediolateral bending relative to the unloaded condition of the posterior J-graft during 3000 cycles of posteroanterior loading was 508 ± 488 µm.The main findings of this biomechanical cadaveric study were that posterior opening-wedge osteotomy and glenoid reconstruction using an implant-free J-shaped iliac crest bone graft restored stability and normalized glenohumeral contact patterns comparable with an intact glenohumeral joint. It also demonstrated secure initial implant-free graft fixation.35 were somewhat promising.32 However, recently published long-term studies have reported that this technique fails to durably restore stability, correct posterior HH subluxation, and prevent progression of osteoarthritis.39Atraumatic posterior shoulder instability associated with excessive glenoid retroversion and posteroinferior glenoid deficiency remains a challenge in shoulder surgery. Neither posterior labral repair nor conventional bone-block procedures can correct the glenoid angular structural deformity. The short-term results of an original technique to correct glenoid retroversion using an opening-wedge glenoid osteotomy as described by Scott12 This procedure combines the traditional Scott osteotomy with reconstruction of the posteroinferior glenoid concavity using an implant-free J-shaped iliac crest bone graft. The use of a J-graft is an established procedure for patients with recurrent anterior instability.13 Its main biomechanical advantage compared with other bone-block procedures is that it re-creates glenoid concavity, which not only has a stabilizing effect but also improves glenohumeral contact patterns.31 In comparison with conventional posterior bone-block procedures,4 the posterior J-graft can also treat excessive glenoid retroversion, as proven recently.12While the aforementioned techniques may not be the key to this unsolved problem, the short-term clinical and radiographic results of the novel posterior J-graft technique appear promising.3 It would be interesting to study other bone graft sources such as distal tibial allograft34 or local autograft from the acromion or scapular spine.30The stabilizing effect of the posterior J-graft was confirmed in this biomechanical study. It not only restored stability to values comparable with those of intact condition with 0° of retroversion but also showed significantly less posterior HH translation compared with the intact condition with 20° of retroversion. Therefore, correcting excessive glenoid retroversion with the posterior J-graft appears to have an additional positive influence on stability in the setting of excessive glenoid retroversion without significant glenoid deficiency. One disadvantage related to this technique remains the donor-site morbidity, which mostly involves postoperative pain and diminished sensation around the scar.18 The current results showed that contact area significantly decreased and contact pressure significantly increased with creation of a Bankart lesion and posteroinferior glenoid deficiency. These differences were even more pronounced with increasing glenoid retroversion of 10° and 20°, respectively. On the other hand, the posterior J-graft restored native contact patterns by reconstruction of the posteroinferior glenoid concavity and correcting glenoid retroversion to 0°. The testing protocol used in this study for evaluation of glenohumeral contact patterns is unique: it considers the physiologic range of posterior HH translation36 and represents eccentric loading of the posterior glenoid, a classic finding in patients with posterior instability associated with excessive glenoid retroversion and dysplasia.38 Whether the posterior J-graft has the potential to slow the development or progression of osteoarthritis remains unclear, but based on this biomechanical study, it appears that it does not lead to increased contact pressure, a concern that was raised with the Scott osteotomy.39Restoration of glenohumeral congruency can normalize glenohumeral contact pressure.The posteroinferior capsulolabral complex was repaired in this study. Yet, the role of extra-articular graft placement in glenohumeral contact patterns needs to be further investigated. With the available results from this study assessing the posterior J-graft procedure, it also remains unclear whether secondary shoulder arthroplasty is easier to perform or more successful because the glenoid version and morphology have been corrected .12 The surgical procedures performed in this biomechanical study were conducted by 2 fellowship-trained shoulder surgeons, both trained by the senior surgeon of the original description. Cyclic loading testing of the graft in this study demonstrated that, when conducted in a technically correct manner, the posterior J-graft achieved excellent initial fixation without any graft breakage reported.The posterior J-graft is technically challenging. Although in the original description, no graft-related complications were observed, it must be noted that the treating surgeons were very experienced.6 Bone and soft tissue quality of the specimens used may differ from in vivo conditions, and the number of different testing conditions and testing cycles applied per specimen may have had a cumulative effect on tissue quality. Last, the magnitude of the minimum detectable difference  and the number of comparisons made are limitations of the sample size used in this study.There are certain limitations associated with this biomechanical study. Static and dynamic stabilizing factors cannot be fully replicated in a cadaveric study. Furthermore, the stabilizing effect of periscapular muscles was not considered, although the capsular complex was kept intact during testing of the intact condition and after repair. The stabilizing effect of the posterior J-graft and its effect on glenohumeral contact patterns represents mainly the early postoperative condition, as the graft usually undergoes a remodeling process.Biomechanical analysis of the posterior opening-wedge osteotomy and glenoid reconstruction technique using an implant-free J-shaped iliac crest bone graft conducted in this study demonstrated that the procedure reliably restores stability and normalizes glenohumeral contact patterns comparable with an intact cadaveric shoulder joint with neutral retroversion. Furthermore, secure initial implant-free graft fixation was found in the cadaveric model.Click here for additional data file.Supplemental material, sj-pdf-1-ajs-10.1177_03635465221128918 for Biomechanical Analysis of Posterior Open-Wedge Osteotomy and Glenoid Concavity Reconstruction Using an Implant-Free, J-Shaped Iliac Crest Bone Graft by Lukas Ernstbrunner, Paul Borbas, Andrew M. Ker, Florian B. Imhoff, Elias Bachmann, Jess G. Snedeker, Karl Wieser and Samy Bouaicha in The American Journal of Sports Medicine


No correlations between age, height, weight, BMI, skinfold thickness and myofascial tissue stiffness were observed (p > 0.5). In conclusion, the IndentoPro is reliable in assessing calf tissue stiffness, but the predictors of stiffness remain unclear.Changes in tissue stiffness are associated with pathological conditions such as myofascial pain and increased risk of muscle injury. Furthermore, they have been shown to modify performance indicators such as running economy or jump height. Indentometry is an affordable way to assess tissue stiffness. However, to date, there is a paucity of studies examining the measurement properties of available devices. With this trial, we aimed to evaluate the reliability of the “IndentoPro”. Two investigators repeatedly measured the stiffness of the lateral head of the gastrocnemius muscle in healthy participants (N = 35), using 5 and 10 mm indentation depths. Intraclass Correlation Coefficients (ICC) revealed moderate inter-rater reliability (5 mm: ICC In recent years, soft tissue stiffness, the resistance of biological structures to an external deforming force ,2,3,4,5,Indentometry is based on the standardized application of a compressive force deforming the underlying structures . Using tBuilding on the basis of said STCM , a new-gSeveral definitions exist for the term “myofascial tissue”, with some authors emphasizing the importance of the intramuscular and intermuscular fascial tissue ,32,33,34A repeated measurements reliability study was prospectively registered in the German Registry of Clinical Trials (ID number DRKS00027417) and conducted in accordance with the Guidelines for Reporting Reliability and Agreement Studies (GGRAS) . BrieflyHealthy participants were recruited based on a convenience sampling technique . The incAll measurements were conducted in a standardized manner and in constant environmental conditions (room temperature constant between 20° and 24° Celsius). Participants were examined in a closed investigation room, respecting the local COVID-19 pandemic regulations. All measurements, per participant, were carried out on the same day, in the dominant leg, and in the prone position. The dominance of the leg was determined by asking the question, “If you would shoot a ball on a target, which leg would you use to shoot the ball?”, as it is a reliable and fast method to determine leg dominance .Measurements were performed on the lateral head of the gastrocnemius muscle, at one-third  of the distance between the knee joint line and the calcaneus. To ensure consistency, the measurement location was marked with a water-soluble marker. First, skinfold thickness was measured once with the skinfold caliper  were placed over the skinfold. Pressure on a press handle was applied with the thumb of the examiner’s dominant hand until the arrow of the press handle matched the arrow on the gauge, and subsequently, pressure was released. The thickness values shown on the scale were registered and used for further analysis.Subsequently, myofascial tissue stiffness measurements were performed. Indentation depth (5 and 10 mm) was chosen based on the possible thickness of the skin and subcutaneous connective tissue in the calf region ,49,50, iThree measurement sets were performed at both indentation depths . For eacA maximal coefficient of variation of 15%  between the trials of each measurement set (M1 to M3) was used as a cut-off score to determine a valid measurement based on the guidelines of the tool producer. No measurement had to be excluded during the study based on that cut-off score. Intra-rater reliability was determined by comparing M1 and M3 measurements at 5 mm and 10 mm indentation depth (Rater 1). Inter-rater reliability was examined comparing M1 (Rater 1) and M2 (Rater 2) measurements at 5 mm and 10 mm indentation depths.Arithmetic means, medians, standard deviations (SD) and the range of variability  were calculated for the quantitative variables. For qualitative variables, the relative frequency of their occurrence (percentage) was used. All quantitative variables were checked for normality using the Shapiro–Wilk test ,52.3,1) was applied [Comparisons of the results obtained in M1, M2 and M3 of the stiffness measurements were performed using non-parametric Friedman tests as an alternative for repeated measures analysis of variance (ANOVA) in order to identify potential systematic differences ,52,53. L applied ,60.p × √(1-ICC)” [p was calculated as “Sp = √(n1 − 1)s12 + (n2 − 1)s22/(n1 + n2 − 2)” [Standard errors of measurement (SEM) were estimated to determine the absolute reliability using the formula “SEM = S(1-ICC)” . The poon2 − 2)” . Bland–An2 − 2)” ,53,62,63To report the quantitative strength of associations between the variables such as skinfold thickness and myofascial tissue stiffness, anthropometric data and tissue stiffness, Spearman tests were chosen ,53,64. Tn = 35 healthy individuals  took part in the study. Detailed characteristics of the sample are presented in In total, Descriptive data are shown in p < 0.001) were found between the different assessments of calf myofascial tissue stiffness, neither at 5 mm indentation  nor 10 mm indentation depth .Since M1 and M3 measurements at 5 mm indentation and M2 measurements at 10 mm indentation showed a non-normal distribution (<0.05), Friedman tests were used to compare the measurements at 5 and 10 mm indentation depths. No significant differences  and intra-rater reliability  showed that the points were scattered in an unbiased pattern, with most of them falling within the limits of agreement.3,1 analyses . Likewise, there was no correlation between skinfold thickness and myofascial tissue stiffness  and myofascial tissue stiffness, in most cases, did not reveal significant associations  was found between tissue stiffness and person characteristics. This is in contrast to earlier studies reporting significant correlations between soft tissue stiffness and sex ,65,66, aSeveral studies ,69,70,71Although no significant differences between the measurements at 5 mm and those at 10 mm were found, the data distribution at 10 mm depth seemed to indicate a trend towards a larger data variability. We suggest that this may be—at least partly—related to a larger variation in the manual pressure orchestration during the stronger tissue indentation process.TM [A variety of limitations must be recognized, and such limitations warrant future research. Firstly, we exclusively conducted stiffness measurements in the human calf region only. Expanding the focus to other body regions  may be of value, particularly because this may allow direct comparisons to other studies using devices such as the MyotonometerTM ,24,25 anTM ,72,73,74This study provides evidence that the IndentoPro is a reliable device to measure myofascial tissue stiffness in the calf region of healthy individuals. However, as no systematic association was observed between stiffness and potential moderators such as skinfold thickness, sex, weight, height, BMI or age, further research is warranted in order to substantiate assumptions on the validity of the tool.


Previous studies have shown that socioeconomic status is correlated to altruistic behavior. The role of empathy as one of the motivations for altruistic behavior is gradually gaining attention among researchers. This study explores the role of empathy in the mechanisms of socioeconomic status and altruistic behavior in Chinese adolescents. A total of 253 middle school students from Northern China participated in this study, which included the dictator game and Interpersonal Relation Index. Results showed that (1) low-SES students behaved more generously than high-SES students; (2) the students were more generous to the low-SES recipients, as shown when offering them more money in the dictator game; (3) affective rather than cognitive empathy mediates the relationship between socioeconomic status and altruistic behavior. The findings provide evidence for the validation of the empathy–altruism hypothesis in a group of Chinese adolescents. Meanwhile, it reveals the path to improving altruistic behavior through the promotion of empathy, especially for individuals of high socioeconomic status. Altruistic behavior is defined as paying a cost to promote the well-being and interests of others, without seeking any benefit in return ,2,3. PriSocioeconomic status (SES), also known as social class, refers to the differences in objective social resources  as well as subjective differences in perceived relative position between groups in different positions in the social hierarchy ,13. EvidEmpathy is the ability to put oneself in the situation of feeling and understanding the emotions and thoughts of others . It refeEmpathy is seen as one of the motivations for altruistic sharing behavior. Batson proposed the empathy–altruism hypothesis, which suggests that when others experience difficulties, observers generate an emotion directed toward the recipient, including empathy, sympathy, and compassion . The greBased on the social cognitive theory of social class, different levels of socioeconomic status elicit social cognition differently, such as empathy . For exaThe social cognitive theory of social class reveals that individuals with low socioeconomic status exhibit higher levels of empathy, and the empathy–altruism hypothesis suggests that high empathy promotes altruistic behavior. Therefore, based on previous research and theory, we infer that empathy may play a mediating role between socioeconomic status and altruistic sharing behavior. A few studies have given indirect evidence for this supposition. For instance, researchers found that high-socioeconomic-status individuals showed less prosocial behavior in contrast with low-socioeconomic-status individuals, while watching a compassion-inducing video could increase their prosocial behavior . In inteIn addition, the essence of altruistic behavior is a social activity that occurs between the helper and the receiver. Therefore, researchers have found that the identity of the recipient is an influential factor in altruistic behavior ,40. IndiThe current study aims to provide more insight into the mechanism underlying the association between socioeconomic status and altruistic behavior and reveal the specific role of empathy in this relationship. Based on the previous literature review, we propose the following three hypotheses.Hypothesis 1 (H1).The helper’s socioeconomic status is negatively related to altruistic behavior, and empathy is positively related to altruistic sharing behavior.Hypothesis 2 (H2).There is an interaction between the socioeconomic status of the helper and the recipient in altruistic behavior. The degree of negative correlation between the helper’s socioeconomic status and altruistic behavior is more sloped when faced with a recipient of low socioeconomic status compared to a recipient of high socioeconomic status.Hypothesis 3 (H3).Empathy mediates the relationship between socioeconomic status and altruistic behavior when the recipient is of low socioeconomic status see .Participants were filtered by a questionnaire on their family monthly income from a middle school in Northern China. Students’ annual family income  was measured previously in another study on this school. Based on the survey data, we knew that the top 27% and bottom 27% of the overall annual income of the sample was 30,000 yuan and 150,000 yuan, respectively . Therefore, we defined the income criteria for grouping low-objective-socioeconomic-status and high-objective-socioeconomic-status families. Students whose family income was less than 2500 yuan per month were classified into the low-objective-socioeconomic-status group , while the ones whose family income was more than 15,000 yuan per month were classified into the high-objective-socioeconomic-status group .r = 0.40) for the association between socioeconomic status and altruistic behavior. We needed at least 142 participants, which could provide 95% statistical power to detect a moderate effect. In this study, a total of 796 student participants from 15 classes in 3 grades, with 5 classes in each grade, were sampled using a convenience sampling method. There were 125 participants in the low-SES group and 128 participants in the high-SES group, for a total of 253 participants included in this study, aged from 11 to 16 years old , and 44.66% were male. We obtained school approval, as well as participants’ own and their parents’ informed consent, before this study. Participants were compensated with small gifts  for completing this survey. We used G * power (Version 3.1) to determine the sample size of this study . Social After giving their informed consent, participants first reported their age and gender. Then, they completed the dictator game. After finishing the dictator game, participants filled in the Interpersonal Reactivity Index Scale.Altruistic behavior was assessed through the amount of money that the dictators offered to the receivers in the dictator game ,20. Two In this study, researchers offered 10 yuan to the dictator and recipient. Participants played the role of a dictator and distributed money (any integer from 0 to 10 yuan) to another middle school student. Each participant finished three trials for three levels of the recipient’s socioeconomic status . The procedure is presented by E-prime 2.0. The first trial was the undefined condition, in which the recipient was described as an unknown middle school student without any additional description. The recipient in the following two trials was described to be a poor or a wealthy unknown student with social cues—for example, he or she wears clothes that are washed white or shoes that are worn with holes, or he/she is wearing designer clothes and shoes. The second and third trials were presented randomly. To avoid the influence of reciprocity and social approval effects on the experimental results, we informed participants that their arrangements were anonymous and that the recipients were different in all three trials. After the last two trials, as a manipulation check, participants were required to rate the economic status of the recipient’s family using a 10-point scale .α of all the items is 0.77, with Cronbach’s α of 0.80 for the subscale of perspective taking and 0.72 for the subscale of empathic concern). Participants completed a measure of perspective taking and empathic concern via the Chinese version of the Interpersonal Reactivity Index (IRI), the most commonly used instrument to measure empathy. The scale was originally developed by Davis, consisting 28 items in 4 dimensions: perspective taking, empathic concern, fantasy, and personal distress ,28. In tSPSS 22.0 was used to analyze the data. Firstly, manipulation checks were conducted, including whether participants in the low-SES group and high-SES group differed in their demographic variables and whether there was a significant difference in participants’ perceptions of the socioeconomic status of the wealthy recipient and poor recipient. Secondly, descriptive analysis and Pearson’s correlations were performed regarding cognitive empathy, affective empathy, empathy (the arithmetic means of cognitive empathy and affective empathy), and altruistic sharing behavior. Then, the moderating effect of the recipient’s socioeconomic status on sharing was tested. Finally, the PROCESS Macro was used to test the mediating effect of empathy, cognitive empathy, and affective empathy in detail, between the dictator’s objective socioeconomic status and altruistic sharing behavior.t test was performed on the demographic composition of the two groups of subjects before data analysis. The results revealed no significant differences between the two groups of subjects in terms of age and gender composition  (see An independent-sample .65) see .t test of the perception of the recipient’s socioeconomic status, which participants rated based on the social cues of the description, was conducted. The score for the poor recipient was 2.87 and the score for the wealthy recipient was 6.95 . This indicates that the descriptions containing social cues caused subjects to feel that the poor recipients were of a lower socioeconomic status than the wealthy recipients. Thus, the socioeconomic status of recipients’ conditions was manipulated successfully. A paired-sample SD = 0.59), and the mean scores for the two dimensions of empathy were as follows: the score for cognitive empathy (perspective taking) was 3.96 (SD = 0.72), and that for affective empathy(empathic concern) was 3.68 (SD = 0.66). As hypothesized, empathy was positively correlated with altruistic sharing behaviors under the three conditions . In addition, both cognitive empathy and affective empathy were positively correlated with altruistic sharing behaviors significantly  = 5.00, p = 0.026, η2 = 0.02. The allocation was higher in the low-SES group  than in the high-SES group . The main effect of the recipient’s socioeconomic status also reached a significant level, F  = 325.24, p < 0.001, η2 = 0.72. Subjects’ allocation was lower when faced with a wealthy recipient  than in the undefined-recipient condition  and poor-recipient condition . In addition, the interaction between the dictator’s objective socioeconomic status and the recipient’s socioeconomic status was significant, F  = 3.98, p = 0.02, η2 = 0.02. Furthermore, a simple effect analysis revealed that the allocations to undefined and poor recipients showed significant differences in the low-SES group and high-SES group (undefined-recipient condition: lsesM  (4.78) > hsesM  (4.55), p = 0.057; poor-recipient condition: lsesM  (7.59) > hsesM  (6.89), p = 0.003). However, in the wealthy-recipient condition, there was no significant difference in the allocation of the two groups, lsesM  = 3.41, hsesM  = 3.42, p = 0.952  of the dictator was the between-subjects independent variable, the socioeconomic status  of the recipient was the within-subjects independent variable, and the amount of money allocated by the dictator to the recipient in the dictator game was the dependent variable. Subsequently, a 2 (dictator’s objective socioeconomic status: low SES/high SES) × 3  repeated-measures ANOVA test was conducted on the amount of altruistic sharing allocation. The results revealed a significant main effect of the dictator’s objective socioeconomic status, .952 see a.1 is a positive increase towards the poor-recipient condition and Δ2 is a negative decrease in the wealthy-recipient condition  = 572.91, p < 0.001, η2 = 0.70, with the amount given to the poor recipient (Δ1)  being significantly larger than the amount given to the wealthy recipient (Δ2) . However, the main effect of the dictator’s objective socioeconomic status was not significant, F  = 0.50, p = 0.48, lsesM  = 0.72, hsesM  = 0.61. The interaction between the dictator’s objective socioeconomic status and the recipient’s socioeconomic status was significant, F  = 5.00, p = 0.026, η2 = 0.02. A simple effect analysis was conducted and discovered that the amount allocated to the poor recipient (Δ1) was significantly different between the low-SES group and high-SES group, lsesM  (2.81) > hsesM  (2.34), p = 0.035; the reduction for wealthy dictators (Δ2) was not significantly different between the two groups, lsesM  = −1.38, hsesM  = −1.13, p = 0.255.Additionally, the allocation amount in the undefined condition was set as the allocation expectation. Setting the expectation as a baseline, the amount of change was formed by subtracting the allocation expectation from the allocation amount when subjects faced poor and wealthy recipients. Δtion see b. A repelow SES, 1 = high SES) and altruistic sharing behavior in the poor- and wealthy-recipient conditions using a bootstrapping procedure with 5000 resamples , accounting for 41.43% of the total effect  in SPSS 22.0 . Accordiβ = 0.14, p = 0.28, 95% CI ), while empathy positively predicted altruistic sharing behavior . The mediation model did not work overall (F (1251) = 0.004, p = 0.95). Thus, empathy did not mediate the relation between the dictator’s SES and altruistic sharing behavior in the wealthy-recipient condition.Although we did not formulate a specific hypothesis about the role of empathy in mediating the relationship between the dictator’s SES and altruistic sharing behavior in the wealthy-recipient condition, we tested the possibility. The results demonstrated that the dictator’s SES could not predict altruistic sharing behavior  rather than cognitive empathy (perspective taking) that mediated the effect. This finding supports Hypothesis 3 and is consistent with previous research showing that affective empathy is more associated with altruistic behavior than cognitive empathy ,36. ThisThis study explored the relationship between objective socioeconomic status and altruistic sharing behavior in Chinese middle school students. It revealed that the participant’s objective socioeconomic status could negatively predict sharing behavior; students of low objective socioeconomic status behave more generously than those of high objective socioeconomic status. In the poor-recipient condition, empathic concern mediated the relationship between the participant’s objective socioeconomic status and altruistic sharing behavior.Previous studies have focused on the influence of the helper’s socioeconomic status on altruistic behavior. The current study provides new research perspectives on the recipient’s socioeconomic status and the mediating role of empathy. The results suggest that situation-related affective empathy can facilitate altruistic behavior directed at helping others in need or distress. The findings provide evidence for the validation of the empathy–altruism hypothesis in a group of Chinese adolescents. The mediating role of empathy may provide some guidance and suggestions on how to improve altruistic behavior among high-socioeconomic-status individuals. For example, broadcasting public service announcements on disadvantaged people can inspire empathy among high-socioeconomic-status individuals and promote their sharing behavior. Given that studies showed that adverse experiences such as low socioeconomic status during childhood and adolescence can lead individuals to exhibit risky behavior and present a time orientation in adulthood, the finding of the mediating role of empathy in this study suggests that parents or teachers can intervene to train middle school students in empathy, so as to reduce such negative effects in the future. Further studies could better explore the mechanisms at play by manipulating or measuring in-group favoritism and out-group bias in such a way that separates group relations from socioeconomic status relations.