After mean follow-up of 33.9 ± 29.3 months, 12 patients died. Linear univariable analysis showed positive associations between PPL and small solute transport, body composition (LBMI and EWexc), comorbidities and performing CAPD (vs. cycler). PPL correlated positively with dialysate appearance rate of IL-6, but not with serum IL-6. Linear multivariable analysis confirmed positive association between PPL and EWexc , LBMI  and performing CAPD . In survival analysis, no relationship was found between mortality and PPL. Multivariable Cox regression showed Charlson Comorbidity Index , overhydration  and lower PPL  were predictors for mortality. Overhydration, was a strong predictor of PPL, overpowering variables previously reported as determinants of PPL, namely clinical correlates of endothelial dysfunction or local inflammation. PPL were not associated with malnutrition or higher mortality, emphasizing the importance of volume overload control in PD patients.Peritoneal protein loss (PPL) has been correlated with mortality, malnutrition and inflammation. More recently overhydration was brought to the equation. This study aims to review classic and recent factors associated with PPL. Prevalent and incident peritoneal dialysis (PD) patients were included. Dialysate and serum IL-6 was obtained during PET. Hydration and nutritional status were assessed by bio-impedance. Linear regression and Cox regression were performed. The 78 included patients presented median values of PPL 4.8 g/24 h, serum IL-6: 5.1 pg/mL, and IL-6 appearance rate 153.5 pg/min. Mean extracellular water excess (EWexc) was 0.88 ± 0.94 L, and lean body mass index (LBMI) 17.3 ± 2.4 kg/m The clinical significance of peritoneal protein loss (PPL) has been a matter of controversy. It has been seen as a detrimental consequence of peritoneal dialysis for many years , 2. ManyIn spite of that, several authors have shown other survival cohorts, refuting the association with PPL with all-cause or cardiovascular mortality , 13–15. Controversy is far from over, and confounders should be identified. By combining critical methodological issues such as effluent and serum biomarkers, the aim of this study is to review classic and recent factors associated with peritoneal protein loss and its consequences on overall mortality in peritoneal dialysis patients.This single center, longitudinal study, included prevalent and incident peritoneal dialysis, from March 2015 to March 2021, with follow up until the 31st December of 2021. Inclusion criteria comprised a modified PET, using 3.86/4.25% glucose solutions and interleukin−6 determination . Simultaneously, a 24-h collection of spent dialysate was obtained. Effluent protein was measured using the biuret reaction method and peritoneal protein loss (PPL) is expressed as grams per 24-h. Hydration and nutritional status were assessed by simultaneous multifrequency bioelectrical impedance . Extracellular water excess (ECWexc) was calculated by ECW measured-−0.613 × intracellular water (ICW) measured . ExceptiBaseline demographics and clinical features were registered, namely age, gender, weight, height, medication, cause of kidney failure, dialysis duration, residual renal urine volume and solute clearance. Charlson Comorbidity Index was calculated at the time of study inclusionAll patients were treated with reduced glucose degradation products content and a normal pH dialysis solution (Baxter® and Fresenius®). The maximum glucose concentration was 2.27%/2.3%. Patients who had active infection or malignancy, experienced acute hospital admissions or a peritonitis episode during the preceding 3 months, were excluded.Collected serum and peritoneal fluid samples were immediately stored at −80°C, until analysis. All samples had one or two freeze–thaw cycles before quantification. For the development of sandwich enzyme linked immunosorbent assays (ELISA), we used the DuoSet® ELISA Development System to measure Interleukin 6 , following the manufacturer's protocols and using all the recommended additional reagents. The ELISA was specific for human IL-6 and did not cross-react with human Recombinant human CNTF, G-CSF, gp130, IL-6 R, IL-11, IL-12, LIF, LIF R, and OSM. Duplicate readings were assayed using a TECAN Infinite®200 multimode reader  for each standard, control, and sample and the average zero standard optical density (O.D.) was subtracted. A standard curve with the value of absorbance vs. the concentration was generated by reducing the data using the Quest Graph™ Four Parameter Logistic (4PL) Curve Calculator  for continuous variables, and median (interquartile range) for skewed distributions. For description of the predictors of peritoneal protein loss uni- and multivariable linear regression were performed. Preliminary analyses were performed to ensure there was no violation of normality and linearity. All variables with a statistical association of Survival analysis, using Cox regression, was performed firstly as univariable analysis. The conditional backward method was used in the multivariate analysis, due to the low number of events. The statistical analysis was performed using SPSS version 22.0. Statistical significance was considered at or below a 5% level.A total of 78 patients were included  out of 118 . Table 1Linear univariable analysis showed positive associations between PPL and (1) small solute transport, as measured by D/P creatinine, (2) body composition, as measured by lean body mass index and overhydration, (3) comorbidities, namely presence of cardiovascular disease or measured by Charlson Comorbidity Index, pulse pressure, older age or male gender , lean body mass index  and performing CAPD  were validated. In the best model, cardiovascular disease was considered without attaining statistical significance , and also albumin was entered in the model . All the other variables with ificance .Overall, 12 patients died . During follow-up. the annual mortality rate of our Unit averaged 6.3%.p = 0.886). A univariable positive association was shown with age , serum IL-6 concentration , pulse pressure , overhydration  and Charlson Comorbidity Index . The presence of cardiovascular disease at baseline assessment showed a trend for worse outcome . Higher serum albumin levels were found to be protective .In the exploratory survival analysis, no relationship was found between mortality and PPL , overhydration  and lower peritoneal protein loss  were predictors for mortality.Cox regression, conditional backward method, variables included are depicted in The purpose of this study was to analyze peritoneal protein loss determinants and to explore prognostic consequences. Most commonly established pathways for higher peritoneal protein leak have been inflammation, in turn associated with peritoneal solute transport rate, and endothelial dysfunction.In the analyzed cohort, the univariable analysis showed a consistent association of PPL with small solute transport and dialysate appearance rate of IL-6. Davies et al., established that peritoneal protein clearance was a function of local inflammation  and not systemic inflammation in patients commencing PD . SupportThe association of PPL and comorbidities, such as measured by Charlson Comorbidity Index, the presence of cardiovascular disease, higher pulse pressure or older age, have been described in several other cohorts, reinforcing the endothelial dysfunction as the origin for such associations , 15, 17.However, multivariable analysis does not support such inferences. The best explicative model enhances overhydration, better nutrition and performing CAPD as best predictors for higher PPL.As for overhydration, previous studies have established a pathophysiologic mechanism: fluid overload as an important cause for increased venous pressure, causing protein escape from the microcirculation in its venular segment due to venular hydrostatic pressure , 17. TheIn the exploratory survival analysis, higher mortality was higher in overhydrated patients, with higher Charlson Comorbidity Index, but not peritoneal protein losses. The importance of fluid overload explains the association between peritoneal protein clearance and mortality reported in some epidemiologic studies and refutes assumptions on a possible role of endothelial dysfunction or inflammation , 26.The present study presents with a number of limitations. It was a single-center cross study with a limited number of participants, mostly in early stage of PD exposure. The low number of deaths and the lengthiness of the study could be a limitation for the survival analysis. Strengths of this study rely on the use of measured total protein for 24 h peritoneal protein loss  and second, the early stage of PD exposure can also be seen as a strength, as it enables insight in normal peritoneal physiology. Third, the use of bioimpedance to evaluate the link between PPL and body composition as an important evaluation tool, allowing the adjustment for multiple confounding covariates. It is recommendable to confirm these results in larger series.This study illustrates the importance of overhydration, as a strong predictor of PPL, overpowering variables previously reported as determinants of PPL, namely clinical correlates of endothelial dysfunction or local inflammation. Also, survival analysis demonstrates the importance of overhydration as a strong prognostic factor. Peritoneal protein losses were not associated with malnutrition or higher mortality, emphasizing the importance of volume overload control, amenable by adjusted dialysis prescription, diuretic and water intake restriction.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Ethics Committee of the Centro Hospitalar Universitário do Algarve (UAIF 192/2019). The patients/participants provided their written informed consent to participate in this study.AM: responsible for the investigational project, elaboration of the manuscript, and statistical analyses. RC and BR: responsible for clinical care and data collection. BR, MTF, MF, and JB: responsible for biological samples care and analysis. AS and AR: responsible for the investigational project and for reviewing the manuscript. All authors contributed to the article and approved the submitted version.This work was funded by the grant numbers UIDB/00215/2020, UIDP/00215/2020, and LA/P/0064/2020 respectively.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


This allows for an improved evaluation of the pelvic area. However, on some occasions, clinicians do observe high excretion of [18F]PSMA-1007 by the renal system. Yet, this sudden differential metabolism of [18F]PSMA-1007 remains poorly understood. In this retrospective study, we aimed to elucidate the incidental high urinary uptake of [18F]PSMA-1007 by assessing the individual patient characteristics, scan (data) and peptide batches.Prostate cancer is one of the most dominant cancers in the Western world. In recent years, the use of positron emission tomography (PET) targeting prostate-specific membrane antigen (PSMA) to image prostate cancer allows accurate diagnosis and staging. Compared to the recently registered PET tracers [18F]PSMA-1007 is predominantly excreted via the hepatobiliary tract resulting in low renal excretion which improves evaluation of the pelvic area. However, some patients do show high urinary uptake of [18F]PSMA-1007. The present study aimed to investigate this sudden high urinary uptake of [18F]PSMA-1007 by evaluating [18F]PSMA-1007 PET scans from PCa patients. In this single-center retrospective study, patients that underwent [18F]PSMA-1007 PET imaging between July 2018 and January 2021 were included. Data regarding the individual patient characteristics, scan acquisition and batch production were analyzed. To determine the urinary excretion of [18F]PSMA-1007, a region of interest was drawn in the bladder, and standardized uptake values (SUVs) were calculated and compared to SUVs in the prostate. An SUVmax of >10 was considered high urinary excretion, an SUVmax 7.5–10 intermediate and an SUVmax < 7.5 low urinary excretion. A total of 344 patients underwent [18F]PSMA-1007 PET/CT imaging, with 37 patients receiving three or more [18F]PSMA-1007 PET/CT scans. The mean SUVmean and SUVmax of the bladder were 3.9 (SD 2.9) and 5.9 (SD 4.2), respectively. Fourteen percent of patients showed high urinary uptake of [18F]PSMA-1007. Twelve of the thirty-seven patients (32.4%) that had multiple scans showed a varying urinary uptake of [18F]PSMA-1007 per PSMA PET/CT scan. In terms of patient characteristics, risk factors, medication and blood laboratory results, no significant influencing variables were found. Nor was there a difference observed in the batch size and the mean radiochemical purity of PSMA-1007 for high- and low-excreting patients. However, the bladder volume affected the mean SUVmax in the bladder significantly, with higher SUVs in lower bladder volumes. In this study, we observed that a higher SUV in the urinary tract seemed to occur in patients with low bladder volume. A prospective study is needed to corroborate this hypothesis.Positron emission tomography (PET) of prostate-specific membrane antigen (PSMA) allows for accurate diagnosis and staging of prostate cancer (PCa). Compared to other PSMA PET tracers available, [ In the last few decades, prostate cancer became one of the most dominant cancers, with more than a million new cases every year ,2. At pr68Ga]Ga-PSMA-11, [18F]DCFPyL and [18F]PSMA-1007 provide promising opportunities to localize prostate cancer and its metastases Ga-PSMA-11 and [18F]DCFPyL imaging is their high renal excretion, causing substantial tracer accumulation in the urinary tract such as the bladder, which hinders the detection of lesions in proximity . This is particularly inconvenient with the current trend of using PSMA PET imaging to evaluate the local prostate tumor [68Ga]Ga-PSMA-11 and [18F]DCFPyL, [18F]PSMA-1007 is mainly excreted via the hepatobiliary tract resulting in much lower urinary uptake and thus allows for improved evaluation of the pelvic area where most prostate cancer lesions are located [18F]PSMA-1007 by the renal system is observed in some patients [18F]PSMA-1007 remains poorly understood. We therefore aimed to elucidate this unexpected higher urinary uptake of [18F]PSMA-1007 by assessing individual patient characteristics, scan (data) and peptide batches.An important limitation of PSMA-1007 PET/CT scans acquired at Radboud University Medical Centre, Nijmegen, The Netherlands, between July 2018 and January 2021 were evaluated. The study was approved by the Medical Review Ethics Committee Arnhem-Nijmegen, The Netherlands (CMO 2020-7244), and all study subjects provided written informed consent and were registered in the ImPRINT registry . All patient characteristics and scan data were collected and recorded in a validated electronic case report form .In this single-center retrospective study, all PSMA-1007 PET/CT scan data were recorded: date and time of scan, the administered activity [18F]PSMA-1007, use of iodinated contrast, standardized uptake values (SUVs) of healthy organs , bladder volume and increased general bone uptake. Moreover, the number, location and SUV of tumors were reported.The following [18F]PSMA-1007 (HPLC).The following tracer data were recorded: batch production, batch size, cold mass of batch PSMA-1007 and radioactivity due to [18F]PSMA-1007 in the kidney parenchyma and pelvis, bladder (center), liver, spleen, salivary glands and healthy bone (hip or acromion), a 20 mm region of interest (ROI) was positioned in each of these organs. In smaller regions, the ROI was reduced to 10 mm . The bladder volume was calculated by the following formula: length × height × width × π/6 (0.523) as commonly used in practice and described previously [PET/CT images were reconstructed by Agfa Healthcare Impax (v6.6.1.5003) integrated with Oasis software . All scans were evaluated following PSMA-RADS by board-certified nuclear medicine physicians with >10 years of experience. To measure the physiological uptake of FPSMA-10018F]PSMA-1007 was linked to high urinary uptake, the bone uptake of each scan was categorized into three groups by examining the maximum intensity projection (MIP): tracer uptake below the blood pool, tracer uptake equivalent to the blood pool and tracer uptake higher than the blood pool . Descriptive statistical methods were used to characterize the study cohort. Stratified data were compared using the chi-squared or Fisher’s exact test for categorical variables and the Mann–Whitney U and Kruskal–Wallis test for continuous variables.Data were managed according to Good Clinical Practice requirements using a validated data capture system .Pearson’s chi-squared or Fisher’s exact test was performed to compare groups of categorical data. All analyses were performed using IBM SPSS Statistics, version 25.0 . In all analyses, a n = 344 men; 100%) underwent [18F]PSMA-1007 PET/CT imaging between July 2018 and January 2021 and met the inclusion criteria. Eleven patients were excluded due to a lack of data in the medical records (including their PSMA PET/CT). Of the total study population, 78, 26, 8 and 3 patients had two, three, four and five PSMA PET scans, respectively. The mean age at the time of the PSMA PET scan was 71 years (SD 7.2 years). Of all included patients, 228 (66.1%) received prior radiotherapy, 225 (65.2%) androgen deprivation therapy, 155 (44.9%) radical prostatectomy and 53 (15.4%) chemotherapy. Hypertension was the most common risk factor (35.7%), followed by diabetes (8.7%) and kidney disease . The [18F]PSMA-1007 (mean) administered activity was 253 MBq (SD 16.1). Iodinated contrast medium was administered to 350 patients (69.3%). None of the patients received loop diuretics  prior to the PET scan. The mean SUVmean and SUVmax of the bladder were 3.9 (SD 2.9) and 5.9 (SD 4.2), respectively. The SUVmean and SUVmax of local prostate cancer lesions were 8.1 (SD 7.5) and 24.8 (SD 23.1), respectively.A total of 344 of the studied patients  scans had a local prostate cancer lesion that was easily delineable with a higher SUVmax of the tumor than the SUVmean of the bladder. Sixty-six scans (13.7%) in 35 patients had an SUVmax > 10 in the bladder urine. The clinical characteristics of scans of patients with high (SUVmax > 10), intermediate (SUVmax 7.5–10) and low urinary (SUVmax < 7.5) excretion of PSMA-1007 and the existence of kidney disorders. However, >20 tumor lesions appeared to be more prevalent in individuals with high urinary uptake of [18F]PSMA-1007 compared to those with low urinary uptake .There were no significant influencing factors identified in disease-related parameters, risk factors, medication, and blood laboratory results . Patientp ≤ 0.001)  . Hence, 18F]PSMA-1007 PET/CT scans. Twelve of these patients (32.4%) showed a differing level of urinary uptake with low and high excretion of [18F]PSMA-1007 between scans. 18F]PSMA-1007 per PSMA PET/CT scan. Between these PET/CT scans, there were no changes in the patients’ medication use, blood laboratory results or introduction of new risk factors. Furthermore, no correlations were discovered based on (pre-)scan data . However, studying the individual scans, it is noticeable that a smaller bladder volume was observed in the case of high urinary uptake compared to the scans without a high uptake, as can be seen in Of the total study population, 37 patients received three or more [18F]PSMA-1007 was a mean of 257 MBq (SD 19.8) in the high-excreting and 253 MBq (SD 15.4) in the low-excreting scans (p = 0.162). There were no significant variations observed in the administration of contrast media between the high-excreting and low excreting patients . 18F]PSMA renal excreting scans (SUVmax of >10.0) and the entire cohort classified by time of the scan, the day of the week and the months since the start of [18F]PSMA PET scans. This was to evaluate if certain dates resulted in higher urinary uptake . In general, no relation was observed regarding the date or time of the PET/CT scan; most of the high-excreting scans were performed on a Wednesday (63.6%), yet this observation did not differ when looking at the entire cohort as most scans were performed on Wednesday (72.3%). However, when comparing the time of the scan with the entire cohort, we observed that high-excreting scans were more frequently performed at the end of the day (3:00–4:00 p.m.) and thus with a longer time between batch production and injection . In 18F]PSMA-1007 (p = 0.099) (The administered activity [SMA-1007 . No stat= 0.099) B.p = 0.297). There was no difference in time between injection of [18F]PSMA-1007 and PET/CT of high-excreting and low-excreting patients (82 min (SD 20 min) vs. 83 min (SD 21 min), respectively; p = 0.242). The time between batch production and PSMA PET/CT was 301 min (SD 74 min) vs. 297 min (SD 67 min) for the high- and low-excreting scans, respectively. 18F]PSMA-1007 PET/CT scan. No difference was observed in the mean radiochemical purity of PSMA-1007 for high- and low-excreting patients (98.4% (SD 1.2%) vs. 98.3% (SD 1.3%)). 18F]PSMA-1007 batch production.All batches were produced around 9 am (SD 28 min). The average batch size was 48.1 GBq (SD 12.3) and 46.5 GBq (SD 13.4) for high- and low-excreting patients, respectively . [18F]PSMA-1007 has a particular advantage over the other PSMA tracers due to a low urinary uptake, which improves evaluation of tumors in proximity of the urinary tract. This is particularly wanted with the current movement to evaluate the local prostate tumor with PSMA PET imaging [18F]PSMA-1007. In an attempt to define which characteristics contribute to this presently undetermined increased urinary uptake, this study evaluated individual patient characteristics, (pre-)scan (data) and production batch data of [18F]PSMA-1007 PET scans.PSMA-1007 or due to batch productions. However, a higher [18F]PSMA-1007 uptake was seen in patients with less urine volume in the bladder. We assume this is caused by a higher concentration of [18F]PSMA-1007 in urine, resulting in higher SUV values on PET imaging. Based on this finding, we suggest adequate fluid intake and no voiding prior to the scan to dilute the [18F]PSMA-1007 in the urine with non-active already present urine. A reasonably filled bladder also has a better contour, which improves the delineation of surrounding organs such as the prostate and seminal vesicles. This hypothesis conflicts with the guideline published by the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the European Association of Nuclear Medicine (EANM) which recommends voiding directly prior to [68Ga]Ga-PSMA-11 and [18F]DCFPyL PET acquisition to reduce the activity present in the urinary system [18F]PSMA-1007 had more (tumor) lesions (>20) than individuals with low urinary uptake. This relationship is unclear to us, since a possible tumor sink effect with unfavorable tracer distribution to the healthy organs in a low-volume disease setting would protect from high renal wash-out PSMA-1007 as neither kidney diseases nor increased creatinine levels were found to affect the SUV of the bladder PSMA-1007 in the first eight hours after the synthesis PSMA-1007 to still unknown targets.Furthermore, while PSMA is highly overexpressed in most prostate cancers and is clinically visualized using PSMA-specific probes, a recent study by Bakht et al. showed that the correlation is not perfect and there may also be active tracer uptake in tissue with low PSMA expression . Therefo18F]PSMA-1007 and control for proteinuria. Unfortunately, this needs to be done in a prospective trial. An additional study is therefore needed to really elucidate the differential urinary uptake between [18F]PSMA PET scans and to test the present outcomes in a more controlled setting.The study has certain limitations: First, the study is constrained by its retrospective collection of data. Second, since our cohort represents a heterogeneous group, we cannot exclude a variety of potential biases that may have affected the outcomes. Third, only limited data of the cold mass were available, as collection of this parameter was difficult. In addition, it would have been appealing to have urine samples post injection to measure the amount of [18F]PSMA PET in the bladder. However, higher SUVs in the urinary tract occurred in patients with low bladder volume. Therefore, adequate fluid intake and no voiding prior to the scan may improve the detection of tumors in proximity of the bladder. Enhanced tracer uptake in the bladder occurs in just a small subset of individuals, and it is therefore unclear how widely this clinical advice should be used. A prospective study is now needed to evaluate the present observations in more detail and to confirm this new hypothesis.In conclusion, we observed that patient characteristics or scanning procedures did not result in a high urinary uptake of [


The aim of this study is to compare the muscle strength, balance ability, thickness, and stiffness of the tibialis anterior and gastrocnemius muscle in the elderly, with  and without  fall experience, and confirmed the correlation between the variables mentioned above and muscle stiffness in the faller. We selected 122 elderly participants, comprising 40 fallers and 82 non-fallers, and measured the muscle strength of the tibialis anterior (TA) and the gastrocnemius (GA). Balance ability was measured by the functional reach test (FRT), timed up and go test (TUG), short physical performance battery (SPPB), and gait speed (GS). We used shear wave elastography (SWE) to determine the thickness of the TA and the medial (GAmed) and lateral head (GAlat) of the gastrocnemius and the stiffness during relaxation and contraction. Balance ability, except muscle strength, was significantly lower in fallers compared with non-fallers. The GAmed and GAlat thickness were significantly lower in fallers than that in non-fallers. In fallers, the thickness, rest, and contractive stiffness of GAmed were correlated with the FRT, GS, SPPB. Low rest and GAmed contractive stiffness were related to lower balance ability in fallers. The muscle stiffness measurement using SWE was a novel method to assess potential fall risk. In older adults, the risk of falling affects their physical ability to maintain independence . These fAccording to a recent study, the stiffness or elasticity of the lower extremity muscles during contraction is correlated with physical functions such as fast walking speed. ,14. UsinEvaluating changes in muscle properties, such as muscle stiffness of the lower extremities rather than muscle strength or physical function, may be more effective in the early recognition of deterioration in balance function in the elderly, such as the risk of fall. Therefore, we aimed to compare the balance ability, muscle strength, thickness and stiffness of the TA, GAmed, and GAlat in community-dwelling and independently living older adults, with  and without fall experience . In addition, we intended to determine the correlation between the above-mentioned parameters and muscle stiffness in fallers. We hypothesized that the stiffness of the TA, GAmed, and GAlat was lower in fallers than that in non-fallers, considering their decreased physical function and that these differences were associated with a decline in balance ability.We performed a cross-sectional trial. All participants were provided detailed information on the study procedure and safety, and they provided their written informed consent. All study procedures were approved by the Institutional Review Board (1044396-202105-HR-097-01), and the study was conducted in accordance with the tenets of the Declaration of Helsinki. Data were collected from July 2021 to August 2021.We enrolled 122 older adults  through various means of community center advertisement, such as posters. The participants were selected by telephonic interviews according to the eligibility criteria. The inclusion criteria were: (1) the ability to independently perform activities of daily living; (2) no history of cardiovascular disease (except hypertension); (3) no history of surgery for musculoskeletal disorders of the lower extremities; and (4) no history of neurological disorders, such as cerebral infarction. (1) Individuals who had a mini-mental state examination score of less than 24; (2) were unable to walk without assistive devices; (3) had premorbid or current orthopedic problems involving the lower extremities; and (4) did not undergo the measurement procedures were excluded.The participants were contacted one day prior to the study date. On the study day, they completed questionnaires on demographic characteristics and fall experience, including the number of falls in the past year. Then, other than assessing their balance and muscle strength, we performed the mini-mental state examination to screen for cognitive dysfunction. Finally, we measured the muscle thickness and stiffness. All data collection was performed at the university laboratory.This study used the G*Power 3.1.7 software  to calculate the sample size, which was determined based on the one-tailed test, power = 0.8, α = 0.05, and effect size = 0.5. The calculated sample size was 102, and a dropout rate of about 20% was considered. A total of 137 elderly participants were recruited; of these, 9 were excluded and 8 did not complete the procedure. The remaining 122 participants were then divided into the experienced  group and the non-experienced  group.The cognitive function of participants was evaluated using the Korean version of the Mini Mental State Examination (K-MMSE) . MMSE isBalance ability was measured by the functional reach test (FRT), TUG time, short physical performance battery (SPPB) score, and gait speed was use for assessing the fall risk. The FRT represents the maximal distance a person can reach forward beyond the arm’s length while maintaining a fixed base of support in the standing position , and it Muscle strength was measured by maximal isometric spontaneous contractions in the dominant leg using a MicroFET2 handheld dynamometer . This battery-operated load cell system has a digital readout of the peak force expressed in Newtons (N). The device can select a high or low threshold for the minimum force required to initiate the test. The device was calibrated by the manufacturer prior to the initiation of the study . The maxWe measured the thickness, rest, and contraction stiffness of the TA, GAmed, and GAlat of the dominant leg. We measured the thickness of each target muscle in a relaxed state, followed by the rest stiffness. Then, the participants were requested to contract the leg for 10 s to measure the contractive stiffness. Thickness and stiffness were measured using an RS85 ultrasound machine  equipped with a 5–10 MHz linear probe. Muscle thickness was measured in cross-section using B-mode . Subsequently, we rotated the probe in the direction of the muscle fiber and acquired the rest and contractive muscle stiffness in the longitudinal plane using the SWE mode. Muscle thickness was measured as the distance between the superficial and deep aponeurosis .For muscle stiffness measurement, the participants were allowed to lie comfortably. With the participant in the supine position, the TA muscle stiffness was measured at a point 1/3rd of the distance between the lower margin of the patella and the first metatarsal base  left 3737. The Gn = 40) and non-fallers (n = 82). We compared differences in all the variables between the groups using the independent t-test. In fallers, we used Pearson’s correlation test to determine the correlation between physical function and muscle thickness and elasticAll statistical analyses were conducted using SPSS version 26 . We analyzed the frequency and used descriptive statistics to assess the participants’ general characteristics. The participants were divided into two groups: fallers  and 82 (mean age: 73.53 years) participants, respectively. p = 0.001), TUG (p = 0.015), SPPB (p = 0.011), and gait speed (p = 0.027) were significantly worse in fallers than in non-fallers. There was no difference in the muscle strength between the groups. Regarding muscle thickness and stiffness, the TA rest (p = 0.021) and contraction stiffness (p = 0.021), GAmed thickness (p = 0.008) and contraction stiffness (p = 0.002), and GAlat thickness (p = 0.014) and contraction stiffness (p = 0.006) were significantly lower in fallers compared to non-fallers  and gait speed . Whereas Gamed rest elasticity was correlated with the SPPB , Gamed contraction elasticity was correlated with the gait speed  and SPPB . However, TA and Galat showed no significant correlations with any of the above parameters.This study compared differences in the muscle strength, muscle thickness and elasticity of the ankle joint, and balance ability between elderly fallers and non-fallers. Despite no difference in the muscle strength, fallers demonstrated significantly decreased balance ability , rest, and contractive stiffness of the TA, and thickness and contractive stiffness of the Gamed and Galat. Moreover, their Gamed thickness, rest, and contractive stiffness were correlated with balance ability. Thus, contractive stiffness has a greater association with falls in older adults than muscle strength of lower extremities.In the elderly, lower extremity strength decreases faster than upper body strength . DecreasAn FRT ≥ 25.40 cm predicts no risk of fall, compared with a value ranging from 15.24 cm to 25.40 cm that predicts a risk of fall within 6 months . The TUGDecreasing muscular strength of the lower limb is associated with an increased risk of falling . HoweverTherefore, we identified GAmed stiffness and thickness as predictive factors for balancing ability in older adults. Accordingly, an evaluation of muscle elasticity of lower extremities could lead to greater reliability of faller detection among elder population. In addition, in this study, the author predicts that fallers would have a slower walking speed in activity daily of living compared to the non-faller. Therefore, authors proposed that power walking such as walking at a high speed may prevent fall risk while maintaining or improving GAmed activities and contractile velocity in the elderly.The present study had some limitations. First, previous studies mentioned that the elasticity and thickness of the rectus femoris were associated with dynamic balance and gait speed . This waThe low rest and contractive stiffness of GAmed was correlated to lower balance ability in the faller group. The GAmed muscle stiffness can be used to effective methods for predicting potential fall risk in the elderly due to balance deterioration.


The good interaction between the ceramic powder and the binder system is vital for ceramic injection molding and prevents the phase separation during processing. Due to the non-polar structure of polyolefins such as high-density polyethylene (HDPE) and the polar surface of ceramics such as zirconia, there is not appropriate adhesion between them. In this study, the effect of adding high-density polyethylene grafted with acrylic acid (AAHDPE), with high polarity and strong adhesion to the powder, on the rheological, thermal and chemical properties of polymer composites highly filled with zirconia and feedstocks was evaluated. To gain a deeper understanding of the effect of each component, formulations containing different amounts of HDPE and or AAHDPE, zirconia and paraffin wax (PW) were prepared. Attenuated total reflection spectroscopy (ATR), scanning electron microscopy (SEM), differential scanning calorimetry (DSC) and rotational and capillary rheology were used for the characterization of the different formulations. The ATR analysis revealed the formation of hydrogen bonds between the hydroxyl groups on the zirconia surface and AAHDPE. The improved powder-binder adhesion in the formulations with more AAHDPE resulted in a better powder dispersion and homogeneous mixtures, as observed by SEM. DSC results revealed that the addition of AAHDPE, PW and zirconia effect the melting and crystallization temperature and crystallinity of the binder, the polymer-filled system and feedstocks. The better powder--binder adhesion and powder dispersion effectively decreased the viscosity of the highly filled polymer composites and feedstocks with AAHDPE; this showed the potential of grafted polymers as binders for ceramic injection molding. Ceramic injection molding (CIM) is an established, accurate, cost-effective and efficient technology for the production of ceramic parts with complex geometries, with increasing interest ,2,3. TheThis study was aimed to investigate the effect of the addition of AAHDPE on the properties of a zirconia feedstock, with PW as the main binder component and HDPE as the polymeric component. In order to do so, different formulations with increasing complexity containing HDPE and or AAHDPE, PW and zirconia were developed; the morphology, rheological, chemical and thermal properties of these formulations were evaluated and compared. To the best of our knowledge, no deep report on the formulations with different constitutes of PW as a plasticizer, AAHDPE as a compatibilizer and zirconia as a filler has previously been published.2/g was obtained from Treibacher Industrie AG,  and was used as filler in the formulation of the ceramic feedstock.High-density polyethylene (HDPE) and acrylic acid-grafted high-density polyethylene (AAHDPE) were obtained from Borealis AG  and BYK-Chemie GmbH , respectively; they were used as a polymeric system. More detailed characteristics and information about HDPE and AAHDPE were stated in our previous study . The parThe different combinations of two polymers , zirconia and PW prepared during this study are listed in 3 . Mixing was carried out at 160 °C and 60 rpm. For the compounding, at first the polymers and PW were fed into the chamber; then, after 3 min the powder was added in 5 batches with 5 min after each addition to ensure the homogenization of the mixture and the stabilization of the torque; after filling, the mixing continued up to a total time of 45 min to facilitate a proper dispersion and homogenization. The molten compounds were extracted from the chamber and cooled down to room temperature. The polymeric system without zirconia (groups A and B) was prepared using the same method to prevent the effect of the thermo-mechanical processing step.Different compounds were processed in a kneader with a mixing chamber with a volume of 38 cmMany trials were conducted for the preparation of feedstock E0. However, due to the low interaction of zirconia and HDPE and the high amounts of zirconia in this formulation, this feedstock failed to prepare. Moreover, the formulations Ax and Cx could not be prepared due to the very low viscosity of PW in a molten state; this led to leakage in the mixing chamber.To prepare the granules, the cutting mill Retsch SM200  was used.To prepare the plate samples suited for doing rotational rheology, the hydraulic vacuum press P200PV  with the program stated in −1 with a resolution of 2 cm−1.The infrared absorption spectra of different samples were obtained by attenuated total reflection spectroscopy (ATR). ATR spectroscopy was carried out using a Vertex 70 spectrometer  at room temperature over a range of 4000–600 cmThe morphology of the polymer-filled materials (groups C and D) and feedstocks (group E) extruded in the capillary rheometer was studied by scanning electron microscopy . The samples were coated with gold prior to SEM observation; and an operation voltage of 20 kV and secondary electron mode were selected for the observation of samples with SEM.−1) [h is the enthalpy fusion of the sample and Δhc is the enthalpy of fusion of a 100% crystalline HDPE. Since the different compounds have different amounts of polyethylene, Δh was normalized with the weight fraction of HDPE and or AAHDPE for each compound.Thermal properties of the different samples were measured by differential scanning calorimetry . The DSC tests were performed in a temperature range of 25–195 °C, using a heating and cooling rate of 10 °C/min and a nitrogen gas flow rate of 50 mL/min. Specimens with a mass ranging from 10 to 20 mg were encapsulated in standard aluminum hermetic pans and the heating–cooling–heating cycles were performed for all the samples. The degree of crystallinity of the polyethylene fraction was calculated by taking the reference enthalpy of fusion of pure HDPE crystals .−1 in the ATR spectra of samples containing HDPE and/or AAHDPE are related to in-plane vibrations of aliphatic hydrocarbons, symmetric and asymmetric stretching of aliphatic hydrocarbons and rocking of the same vibrational group in the structure of HDPE and AAHDPE, respectively [ATR spectroscopy was used to evaluate chemical changes in the different formulations. To investigate the homogeneity of samples, three different measurements were performed for each sample at three different points; no difference was observed between the measurements, indicating the homogeneity of the samples prepared from different formulations (data not shown). ectively ,20.−1 correlates to the stretching vibration of the carboxyl (C=O) of acrylic acid group in the formulations containing AAHDPE. The presence of a peak at around 2954 cm−1 in the FTIR spectra of samples containing PW corresponds to the presence of PW in the mixture according to previous literatures [−1 in the C, D and E groups is related to presence of zirconia [The existence of the peak at 1714 cmeratures . As PW izirconia .−1). The shift of the carboxyl groups peak can be attributed to the presence of hydrogen bonds between the hydroxyl groups in the zirconia surface and carboxyl groups, as observed in our previous study [−1 in formulations containing AAHDPE than in those with only HDPE (C100 as compared to C0) can be a sign of a better covering of the powder surface by the polymer.No new peak or significant peak shift was observed due to the formation of a chemical bond between the HDPE or AAHDPE with PW or zirconia. However, a slight shift of the carboxyl groups of the acrylic acid to lower wavelengths can be observed when comparing the formulations containing AAHDPE with and without zirconia; e.g., A100 and C100 ; this might be due to the plasticizing effect of PW. However, the comparison between the samples with and without PW (A vs. B and C vs. D) clearly indicates that the presence of PW does not have noticeable effect on the crystallinity of the samples. Matula et al. also reported that paraffin significantly reduces the melting point of polypropylene and HDPE .As shown, the formulations containing zirconia have higher melting temperatures compared to those without zirconia; further, these differences are more significant for formulations without PW (group A vs. C). The crystallization temperature decreased by including zirconia into the structure of binders without PW, meaning the delay of crystallization by including zirconia in the structure of binders; this is likely due to the higher distance between polymeric chains in the presence of zirconia (group A vs. group C). For formulations containing PW (B vs. D), the reduction in the crystallization temperature was more remarkable for the combinations containing AAHDPE. No noticeable difference between the melting and crystallization temperature was observed for the formulations containing 30 vol% and 50 vol% zirconia (D vs. E).Understanding the rheological properties is important as it gives us information regarding the internal structure of materials; and an estimation of the processing conditions for practical polymer processing, such as injection molding. Viscosity is the most important property of filled-polymeric systems, which is measured using either capillary or rotational rheometric methods ,25. AlthPseudoplastic behavior was observed for A0, A50 and A100 in the range of angular frequencies assessed during this study a. PseudoThe complex viscosity of A50 was found to be much lower compared to that for A0 and A100. Due to the presence of HDPE and AAHDPE in the structure of A50, the hydrogen bonds between AAHDPE might not be as strong as A100 since there are HDPE chains between AAHDPE chains. Moreover, the entanglements between HDPE chains are not as strong as in A0 as there are AAHDPE chains in the space of HDPE chains. As A50 likely has lower amounts of entanglements and hydrogen bonds between polymeric chains compared to A0 and A100, it could result in a significantly lower complex viscosity for A50.The storage and loss modulus indicate the elastic and viscous behavior of materials, respectively . The samThe loss factor or tan delta is defined as the ratio of loss to storage modulus; it is a helpful parameter to indicate the relation between the elastic and viscous fractions of viscoelastic materials. As can be seen in The complex viscosities of the binders containing PW (group B) were found to be significantly lower than those for the binders without PW (group A); this can be attributed to the low viscosity of PW . PW has −1. As illustrated in A behavior similar to the complex viscosity was observed for the storage and loss moduli of B0, B50 and B100. However, the difference between the loss modulus of the samples containing PW is not noticeable, especially at angular frequencies less than 1 rad·s−1 for the C, D and E groups. Pseudoplastic behavior was observed for all of the samples. No noticeable difference was observed for the viscosity of C0 and C100; while the viscosity of C50 was found to be the lowest one in the evaluated apparent shear rates range  presented in the structure of AAHDPE, the entanglements between the polyethylene chains and the interaction between PW and the polyethylene molecules. For the formulations containing zirconia , the incorporation of AAHDPE is needed to guarantee a continuous flow and low viscosity. In fact, the increase in the AAHDPE content facilitates the incorporation in the feedstocks. The results of this study provide a better insight into the powder-binder interaction in ceramic injection molding feedstocks; in addition, they show the potential of grafted polymers as binders for CIM and similar processes based on polymer systems highly filled with ceramic powder.


The Wrap closure also increased heel contact area, which is also associated with fit. This increase may be associated with the subjective preference for the Wrap. Lastly, runners had a small but significant increase in running speed in the Wrap shoe with no differences in heart rate nor subjective exertion. In total, the Wrap closure fit better than the Lace closure on a variety of terrain. This study demonstrates the feasibility of detecting meaningful biomechanical differences between footwear features in the wild using statistical tools and study design. Evaluating footwear in ecologically valid environments often creates additional variance in the data. This variance should not be treated as noise; instead, it is critical to capture this additional variance and challenges of ecologically valid terrain if we hope to use biomechanics to impact the development of new products.Trail running participation has grown over the last two decades. As a result, there have been an increasing number of studies examining the sport. Despite these increases, there is a lack of understanding regarding the effects of footwear on trail running biomechanics in ecologically valid conditions. The purpose of our study was to evaluate how a Wrap vs. Lace closure (on the same shoe) impacts running biomechanics on a trail. Thirty subjects ran a trail loop in each shoe while wearing a global positioning system (GPS) watch, heart rate monitor, inertial measurement units (IMUs), and plantar pressure insoles. The Wrap closure reduced peak foot eversion velocity (measured  Trail running participation, particularly in ultra-distances, has grown over the last two decades , 2. As aFootwear is a key piece of equipment that that impacts running performance in road running , 10. Whivia force plates) and reduced pronation (eversion) velocities  to evaluate how changing a trail shoe closure system impacts trail running biomechanics and performance, and (2) to highlight an experimental paradigm for testing biomechanical interventions on a trail. Specifically, we evaluated trail running in the La Sportiva Cyklon with a Wrap closure and a Lace closure with respect to preference and performance. We hypothesized that the Wrap closure would provide a better fit than the Lace closure. We anticipated a shoe with a better closure would: (1) reduce foot eversion velocity, (2) reduce loading rate as measured by peak acceleration or peak jerk, (3) reduce the medial/lateral acceleration, (4) reduce peak pressure in the toe and/or the heel, and (5) increase the contact area in the toe and/or the heel. We evaluated the peak jerk in addition to the peak acceleration as jerk provides a similar time-derivative as loading rate. We also evaluated subjective and objective (heart rate) measures of exertion to ensure that there was no difference in effort between the two shoes.Thirty subjects  provided written informed consent prior to participation in trail running. The protocol was approved by the Institutional Review Board (protocol: 22-BOAT-101). Participants with US men's shoe size 10 and 11 and US women's shoe size 7.5 and 9 were recruited for this study. To be eligible to participate, subjects were required to run at least 24 km per week and participate in trail running once per week (weather permitting) with no injuries that resulted in missing more than a week of running in the past six months. All participants ran in the La Sportiva Cyklon (Wrap) and a retrofitted La Sportiva Cyklon with Laces (Lace) .The trail run was performed on a 1.6 km loop near Morrison, Colorado, USA  and had After running the warm-up lap, the subjects reviewed the questionnaire. After each lap in a study condition, subjects rated their exertion on an ordinal scale of 0 (not tired) to 10 (exhausted). After the second run in each shoe, they responded to questions regarded the performance of the shoe for uphill, level, and downhill running. Subjects also rated their confidence while running in the shoe. Finally, subjects rated the overall fit, the forefoot fit, midfoot fit, and the heel fit. All questions besides the fit for the specific foot regions were rated on an ordinal scale from zero to 10, where zero was “poor” and 10 was “great”. For the specific foot regions , zero corresponded with too loose, five was perfect and 10 was too tight. Similar ordinal scales have been shown to be a reliable assessment of footwear comfort during running . For theThe IMUs  were used to determine running speed, peak acceleration (sometimes referred to as shock), jerk, medial-lateral acceleration ranges, and peak eversion angular velocity. We first combined the low-g and high-g accelerometer data to avoid saturation that can occur during running . This waAverage heel and toe contact area along with peak toe and peak heel pressures during the stance phase of running were extracted from the plantar pressure. Running stance phase for the plantar pressure was detected with implementing a gradient decent algorithm on the total insole force to provide foot-contact and toe-off events. The heel region was defined as the rear 20% of the plantar pressure sensor. The toe region was defined as the front 20% of the sensor. These two regions are defined though the XSENSOR software and approximately correspond to the respective regions of the anatomical foot. All pressure metrics were extracted after the detected three hops for the entire running loop.The GPS coordinates from the watch were used to segment the trail into three portions: uphill, top technical, and downhill see  above baLinear mixed effects models were used to evaluate the statistical difference between the Wrap and Lace shoes for the subjective outcomes along with biomechanical outcomes. All statistical analyses were performed in R Statistical Software (version 4.1.2) with the LMER  and emme subject . DiffereOutcome”) were then evaluated with a mixed effects model with an independent (random) intercept for each subject and independent slope encoding the subject-specific effect of switching from one shoe condition to the other .p ≤ 0.002, p < 0.001). Though the Wrap shoe was rated with a better overall fit (p < 0.001), the Wrap shoe was rated as tighter than the Lace shoe in the forefoot (p = 0.04) with no differences in rating for the midfoot or heel fit (p > 0.1).The Wrap shoe was subjectively rated better for uphill, level, and downhill running (p = 0.46) or objective exertion outcomes . The peak eversion velocity was on average 5% lower in the Wrap than the Lace for the uphill (p = 0.025), technical top (p = 0.008), and downhill (p = 0.043) portions of the trail.Subjects ran slightly faster in the Wrap than in the Lace shoe on all three sections of the trail . Both the peak heel and toe pressures did not differ between the two shoes for any section of the trail (p > 0.087).The average percent heel contact area during the stance phase of running increased by an average magnitude of 2% in the Wrap over the Lace for all sections of the trail  to be included as a covariate, instructed all participants to run at similar speeds for each section of a trail, and used a trail loop that could be completed four times within a single session without substantial changes in RPE so subjects could be tested in a counterbalanced order. We also measured their running speed, heart rate, and rating of perceived exertion, which could be included as covariates in our statistical model. For instance, including running speed  to maintain statistical power. A mixed effects model that includes each individual step from each subject allows for the inter-individual variability in biomechanical measures to be accounted for in the analysis. Critically, footwear features such as fit and outsole features are often designed to mitigate the exact challenges that contribute to this variability such as sloppy rocks and steep gradients. Therefore, to test these design features it is essential to test these products on a trail. To the second aim of our study, we performed a repeatable experimental design to test trail products in an ecologically valid setting while limiting confounding variables. We segmented the trail into three unique sections Trail terrain is a critical benefit to evaluating the effects of footwear features. In the laboratory, it is common to evaluate shoe features e.g., , 43] and and43)] There are several limitations to acknowledge. Both the experimenters and the subjects were unable to be blinded to the footwear conditions. Additionally, the insole and IMU data were not able to be aligned post-hoc. As such, statistical analyses that account for running speed  could noThe wrap shoe provided improved qualitative and quantitative fit as compared to the lace version of the same shoe. Moving forward, shoe manufacturers and trail runner alike may want to choose shoes with wraps over laces for enhanced fit.


There are a variety of internal fixation methods for unstable femoral neck fractures (FNFs), but the best method is still unclear. Femoral neck system (FNS) is a dynamic angular stabilization system with cross screws, and is a new internal fixation implant designed for minimally invasive fixation of FNFs. In this study, we conducted a biomechanical comparison of FNS, InterTan nail and three cannulated screws for the treatment of Pauwels III FNFs and investigate the biomechanical properties of FNS.A total of 18 left artificial femurs were selected and randomly divide into Group A (fixation with FNS), Group B (fixation with InterTan nail) and Group C (fixation with three cannulated screws), with 6 specimens in each group. After creating Pauwels type III FNF models, the specimens in each were tested with non-destructive quasi-static tests, including torsion, A-P bending and axial compression tests. The average slope of the linear load–deformation curve obtained from quasi-static tests defines the initial torsional stiffness, A-P bending stiffness, and axial compression stiffness. After cyclic loading test was applied, the overall deformation of models and local deformation of implant holes in each group were assessed. The overall deformation was estimated as the displacement recorded by the software of the mechanical testing apparatus. Local deformation was defined as interfragmental displacement. Data were analyzed by one-way analysis of variance (ANOVA) followed by Bonferroni post hoc test using the SPSS software . Correlation analysis was performed using Pearson’s correlation analysis.P < 0.01), while Group A had significantly higher axial stiffness and A-P bending stiffness than Group C (P < 0.01). Groups A and B exhibited significantly higher torsional stiffness than Group C (P < 0.01), no statistical significance was observed between Groups A and B (P > 0.05). Group B exhibited significantly lower overall and local deformations than the other two groups (P < 0.01), while Group A had significantly lower overall and local deformations than Group C (P < 0.01). Correlation analysis revealed positive correlation between axial stiffness and A-P bending stiffness , torsional stiffness , between torsional stiffness and A-P bending stiffness; negative correlation between overall, local deformations and axial stiffness , and positive correlation between the two deformations .Group B exhibited significantly higher axial stiffness and A-P bending stiffness than the other two groups (For fixation of unstable FNFs, InterTan nail showed the highest axial stiffness and A-P bending stiffness, followed by FNS, and then three cannulated screws. Torsional stiffness of FNS was comparable to that of the InterTan nail. FNS, as a novel minimally invasive implant, can create good mechanical environment for the healing of unstable FNFs. Clinical studies are needed to confirm the potential advantages of FNS observed in this biomechanical study. The incidence of femoral neck fractures (FNFs) accounts for 50% of all hip fractures, and is considered a major public health problem with high socioeconomic burden . AlthougDuring the treatment of FNFs, with the establishment of anatomical reduction, the maintenance of fracture stability largely relies on internal fixation. The ability of the internal fixation device to provide good stability becomes a key factor in maintaining fracture reduction and stabilization. Pauwels type III FNFs are considered more unstable due to the high shear stress of these fractures, so it is required that implants used for fixation of Pauwels type III FNFs should provide optimal mechanical resistance , 11. IntHowever, the effect of FNS for fixation of Pauwels type III FNFs in terms of axial stiffness, anteroposterior (A-P) bending and torsional stiffness has not yet been compared with cannulated screws and InterTan nail. Therefore, the purpose of this study was to compare the difference in biomechanical properties between FNS, cannulated screw and InterTan nail for fixation of Pauwels III FNFs using non-destructive loading test. We hypothesize that FNS may improve fracture stability.P < 0.01). Group B exhibited the highest axial stiffness and A-P bending stiffness, followed by group A, and then Group C.As shown in Table There were no statistical significance in the torsional stiffness between group A and B. Torsional stiffness was comparable for FNS and InterTan nail, whereas the lowest torsional stiffness was observed in Group C.P < 0.01, Table Group B exhibited better biomechanical stability than Group A and C in the cyclic loading test Fig. . There wP < 0.01), torsional stiffness (P < 0.01), as well as between torsional stiffness and A-P bending stiffness , while positive correlation was found between the two deformations  for fixation of Pauwels type III FNFs. Our results showed that InterTan nail exhibited highest axial stiffness and AP bending stiffness, followed by FNS, and then 3 cannulated screws. This may be due to that during axial compression and AP bending, fixation with InterTan nail and FNS can transfer the stress on the femoral head to the femoral shaft, while fixation with 3 cannulated screws relies on the “three-point support principle”, which transfers torque through the interaction between the screw and the cancellous bone. InterTan nail is an intramedullary fixation device with main nail located in medullary cavity of the femoral shaft, and a short level arm, which can produce high mechanical strength upon A-P bending and axial loading. FNS is an extramedullary angular stabilization device. Although FNS can transfer stress to the femoral shaft, its force arm is long, this is the reason why FNS was inferior to InterTan nail in terms of axial stiffness and A-P bending stiffness. Additionally, considering the design of FNS , FNS is relative unstable (short bone plate) and weaker in the initial stability (fixed by few screw) than the InterTan nail. Our findings demonstrated superior fixation strength of FNS and InterTan nail compared with three cannulated screws. Under normal conditions, 1400 N–1500 N force was loaded to the hip joint during daily activities . And insThe overall deformation of the models and local deformation of implant holes can reflect displacement during the fracture healing process. In this study, correlation analysis revealed negative correlation between overall, local deformations and axial stiffness Table . InterTaIn this study, we found an interesting phenomenon, i.e., the torsional stiffness of the FNS and InterTan nail was superior to that of cannulated screws, while there was no significant difference in the torsional stiffness between FNS and InterTan nail groups. Three cannulated screws are placed in parallel and distributed scatteredly close to the bone cortex, which can form a triangular support base with the largest area on lateral femoral wall, therefore, providing better holding power in the femoral head . During A biomechanical comparison of FNS and sliding hip screws, cannulated screws in unstable Pauwels III FNFs conducted by Stoffel et al.  showed tIt is worth noting that the results from in vitro biomechanics studies should not be fully equivalent to the results of clinical treatment. However, the evidence from biomechanical studies plays an important role in the short-term safety assessment of implants for use in clinic . AlthougThis study has several limitations. First, we selected artificial composite bone for biomechanical testing: in comparison with human cadaveric femurs, artificial composite femurs have the advantages of being easier to store, cheaper and easier to obtain, and artificial composite femurs are not biohazardous with minimal variation between specimens. In addition, there are no statistically significant differences between artificial composite bone and human cadaveric femurs with respect to various mechanical stability parameters . HoweverFor the unstable FNFs, both FNS and InterTan nail showed higher stability compared with 3 cannulated screws. In terms of axial stiffness and A-P bending stiffness, InterTan nail was superior to FNS and 3 cannulated screws, and FNS was superior to 3 cannulated screws. FNS also showed torsional stiffness comparable to that of the InterTan nail. FNS, as a minimally invasive implant, its biomechanical advantages may be beneficial for clinical application, which is expected to be a promising internal fixation implant for fixation of unstable FNFs. However, further clinical studies are needed to confirm our findings.A total of 18 left artificial femurs  were selected and randomly divide into FNS group , InterTan nail group , and cannulated screw group , with 6 specimens in each group. Specimen preparation and implant placement were performed by the same orthopedic surgeon to ensure consistency. Holes were predrilled in all specimens with a guide pin matching the implant prior to osteotomy in order to ensure standard placement of the implants under an anatomical reduction status after osteotomy. In groups A and B, guide pin was inserted along the central axis of the femoral neck in both the AP and later views by using a guide under G-arm fluoroscopy guidance, following the manufacturer’s instructions, then holes were predrilled. In group C, according to the position of cannulated screw placement recommended by Heetveld et al.  and BoscTo ensure standard placement of the implants within and between groups, implants were placed under G-arm fluoroscopy guidance. In group A, after enlarging holes under the guidance of the guide pin, special insertion instrument assembled with bolt and locking plate was inserted along the axis of the femoral neck until the tip reached to a distance of 5 mm distal from the subchondral bone, and the locking plate was placed on the longitudinal axis of the femoral shaft. The anti-rotation and locking screws were then inserted after enlarging the holes gradually under the guidance of a special guide, followed by applying pressure on the fracture ends. In group B, the guide pin of intramedullary InterTan nail was inserted slightly medial to the apex of the greater trochanter. The guide pin was at an angle of 4° to the femoral anatomical axis in the AP view, and was in line with the femoral medullary cavity in the lateral view. After reaming, the intramedullary nail was inserted, the lag screw guide pin was then inserted through the pre-drilled holes. After reaming, the lag screw was inserted along the axis of the femoral neck with a tip–apex distance less than 15 mm confirmed by fluoroscopy . ThroughThe artificial femurs were mounted by a fixture attached to the base of an Instron E10000 testing machine  with a measurement range of ± 10 KN, accuracy of ± 0.5%, torque measurement range of ± 100 Nm, and torque measurement accuracy of ± 0.5%. The loading and displacement were recorded by the software of the Instron E10000 testing machine.According to the method reported by Zdero et al. , in ordeAfter the static test was completed, the femur was still positioned in the vertical orientation and subjected to axial dynamic cyclic test under sinusoidal load control. To prevent slipping of the femurs, the valley load was kept at a constant level of 60 N throughout the test. Subsequently, the dynamic load was applied at the femoral head with sinusoidal motion using load control  . The 140The average slope of the linear load–deformation curve obtained from quasi-static tests defines the initial torsional stiffness, A-P bending stiffness, and axial compression stiffness . After tP < 0.05. Pearson’s correlation analysis was used to determine the correlation between axial stiffness, A-P bending stiffness, torsional stiffness, as well as between overall, local deformations and the axial stiffness after cyclic loading tests.Statistical analysis was carried out using the SPSS software . Data were tested for normality using the Kolmogorov–Smirnov test. After confirming data normality, the differences in axial stiffness, A-P bending stiffness, torsional stiffness, overall deformation, and local deformation of holes between 3 groups were analyzed using one-way analysis of variance (ANOVA) with Bonferroni post hoc tests for multiple comparisons. The 95% confidence interval was used for considering statistical significance. The level of significance was set at


Danio rerio) embryos. Exposure was carried out from 0–120 hours post fertilization (hpf) to 6 different concentrations of the model compound propranolol (PPL). Following in-plate extraction and non-target instrumental analysis by high resolution mass spectrometry, suspected bioTPs were identified using custom data filtration scripts and matching to in silico structural predictions. A total of eight PPL bioTPs were identified (five at a level 1 confidence and one at a level 2–3 confidence). These findings supplement previously generated toxicometabolomic models derived from the same dataset, and were obtained without conducting additional exposure experiments. In addition to facilitating assessments of inter-individual variability in bioTP production in ZF embryos, we demonstrate that bioTPs can be elucidated using extremely small quantities of biomass (i.e. ∼200 μg). To the best of our knowledge, this is the first time bioTP elucidation has been carried out in single ZF embryos.A procedure was developed for rapid screening of xenobiotic biotransformation products (bioTPs) in single zebrafish  embryos.A procedure was developed for rapid screening of xenobiotic biotransformation products (bioTPs) in single zebrafish (ZF;  In pharmacotoxicology it is essential to establish that a drug does not generate toxic biotransformation products (bioTPs) within patients, to which end the European Medicinal Agency (EMA) and the US Food and Drug Administration (FDA) have both issued regulatory documents underlining the importance of detection and quantification of drug bioTPs during development of pharmaceuticals.6–9 While as little as ∼16% of orally administered PPL is excreted unchanged, few studies have measured PPL bioTPs in the aquatic environment and only a single study has attempted identification of PPL bioTPs in fish.10–17 In that work, 5 bioTPs were identified, but structures remained tentative due to a lack of high resolution data or authentic standards. Further investigations into the formation and occurrence of PPL bioTPs are clearly important because PPL and mixtures of PPL bioTPs (produced through S9 incubation) have previously been shown to have similar biological effects.10,18,19The non-selective beta-blocker propranolol (PPL) was first synthesized in the 1960s and is heavily prescribed to patients suffering from a range of heart-related diseases. The extensive use of PPL has led to its global occurrence in natural waters downstream from WWTPs.Danio rerio) are frequently used to study human disease. Conservation of many common enzyme homologues between humans and ZF has led to an increased use of ZF of all life stages for studying xenobiotic biotransformation.20–26 Assays involving ZF embryos, which are considered an in vitro model under European Union legislation, are advantageous compared to their in vivo counterparts due to reductions in time, cost, and animal usage.27In vitro screening of bioTPs of aquatic pollutants have thus far predominantly been carried out using S9 liver fractions from fish.28–30 Although these tests share similar benefits to ZF embryos (relative to in vivo studies), they only consider biotransformation in the liver and do not account for uptake and elimination processes. To the best of our knowledge, all ZF embryo biotransformation experiments performed to date have involved pooled embryos and require a second experimental setup when combined with toxicological studies.21–26,31–35 While pooling of embryos can be advantageous for detecting lower abundance bioTPs, cost and throughput may be improved by using single embryos. Moreover, single embryo screening offers the opportunity to connect apical endpoints to extreme transformation profiles in individuals, and to measure inter-individual variability in biotransformation.Due to their high genetic similarity to humans, zebrafish . To the best of our knowledge, this is the first time bioTP elucidation has been carried out in single ZF embryos and highlights the potential for re-purposing non-target metabolomics data for bioTP identification and for extracting information on bioTPs from extremely small sample sizes.In this study we developed a rapid screening procedure for xenobiotic biotransformation in single ZF embryos using existing non-target data from a toxicometabolomic study involving PPL.22.1N-desisopropyl propranolol  and 4-hydroxypropranolol hydrochloride  were purchased from Merck . 4-Hydroxypropranolol sulfate potassium , propranolol glucuronide , 4-hydroxypropranolol glucuronide  was purchased from ALSACHIM . 1-Naphthol  was purchased from Alfa Aesar . All other standards and reagents used in this study are described in detail elsewhere.36PPL (99% purity), 2.236 Briefly, single ZF embryos were exposed to six concentrations of PPL , 40 000 μg L−1 of the positive control 3,4-dichloroaniline (12 embryos) and to clean tank water (12 embryos) in a 96-well plate (wp) from 0–120 hours post fertilization (hpf). At termination, exposure water was removed and embryos were subsequently frozen on dry ice, transported to Stockholm University and stored at −80 °C. Extraction was carried out by homogenizing the embryos in-plate using mixed-size, stainless steel beads together with a mixture of methanol and chloroform containing a metabolite internal standard  by injecting exposure water collected from individual wells of the 96-well plate.36 Non-target data, which were re-interrogated in the present work for bioTPs, were obtained by injecting embryo extracts onto an Ultimate 3000 LC equipped with an in-line filter prior to the chromatographic column. The LC was connected to a QExactive HF Orbitrap high resolution mass spectrometer  operated in full scan with data-dependent MS2 acquisition, based on the three most intense peaks per full scan. Two analyses were performed per sample, utilizing either a BEH amide hydrophilic interaction liquid chromatography (HILIC) column  with the MS operated in positive electrospray ionization (ESI) mode, or a T3 Atlantis C18 column (Waters) with the MS operated in negative ESI mode.36,37Details of the instrumental analysis have been described previously.2.4Generate expected compounds”-node which predicts exact masses of potential phase I and II bioTPs of a structure supplied by the user . The limit of 1 was set in order to avoid removing real PPL bioTPs due to noise present in a single sample. Finally, we calculated an enrichment factor (EF) by dividing each feature's normalized area in the highest dose (where bioTPs are expected to occur in highest abundance) by its average area in negative controls. Features with EFs ≤10 were subsequently removed. All remaining features were then manually scrutinized in CD to confirm that features of interest were absent in control samples, that the signal in the exposed samples had a logical gradient , and to assess MS2 data. If a theoretical bioTP mass (as predicted by CD) had several possible transformation pathways, the one with the highest fragment ion searching (FISh)-score (i.e. how well fragments match to an in silico generated collision-induced dissociation (CID) pattern of the suggested chemical structure) was selected. Finally, to obtain a less biased structural confirmation of the identities proposed by CD, MS2 data from the highest two doses were converted into mzXML-format prior to analysis using SIRIUS + CSI:FingerID (referred to herein as simply “Sirius”).39–41 Sirius utilizes MS1 and MS2 spectra to predict chemical formulae for parent compounds and their fragments and compares the predictions to a range of databases , it requires the user to optimize peak picking parameters prior to usage.42 Since the data in our study was processed using CD, the time investment to fully optimize XCMS or OpenMS settings would be comparable to simply using Sirius. However, when combined with the bioTP prediction capability of CD and the prioritization workflow outlined above, the time required to utilize Sirius for structure predictions is markedly decreased. Lastly, all identified bioTPs were re-processed using XCalibur 3.0.63  since this software was more effective than CD for manual inspection of MS2 data, for assessing the occurrence of in-source fragments and peak integration. All correlation analyses were carried out using Spearman's rank order correlation tests.Compound Discoverer 3.1  was used for non-target peak picking and retention time (RT) alignment. Peak picking was configured to only approve compounds with one matching isotopic peak and to combine peaks determined to be adducts into a single feature. The workflow employed for processing in CD also included the “2.536Structures identified using CD and Sirius were confirmed by analyzing authentic standards (when available) fortified into both pure solvent and also non-exposed ZF embryo extracts (to assess the effect of matrix on retention times). These standards were then analyzed under the same instrumental conditions that were used for analysis of the original embryo extracts.43 MSMSsim assesses the similarity of two spectra, within a time window specified by the user, and provides a score between 0 (no similarity) and 1 . Scores ≥90% were considered sufficient to conclude a positive match between standard and sample. The scale described by Schymanski et al. was used to denote the level of confidence (CL) in the molecular structures.44The R-script MSMSsim was used to compare MS2 data obtained from standards to that of samples  were obtained from both datasets. The neutral masses (Da) for these suspects were: 133.11014 (2 features in HILIC), 178.08328 (C18), 182.07288 (HILIC), 217.1102 (2 features in HILIC [average mass from both features]), 274.15269 (HILIC), 275.15218 (2 features in HILIC), 293.16258 (HILIC), 355.10882 (HILIC + C18), 396.17211 (HILIC), 435.18913 (HILIC + C18), 451.18410 (HILIC + 2 features in C18), 635.27319 (C18) and 651.26804 (HILIC).3.2Among the 20 features obtained following prioritization, the mass at 178.08328 Da (C18) was removed due to its prevalence in blanks. The remaining features were subjected to further investigation using Sirius together with FISh scoring and matching in mzCloud (when possible). For one of the features at 217.11029 Da observed in HILIC (RT = 3.431 min), the PPL bioTP DIP-PPL was the top prediction in 100% of MS2 spectra investigated by Sirius. FISh scoring revealed matches to DIP-PPL for 8 fragments . For the feature at 3.194 min, PPL-4OH was the top prediction in 100% of investigated MS2 spectra by Sirius. PPL-4OH was also matched by mzCloud (94.6%) and 18 fragments  and C18 (m/z 354.10165). Both features were strongly correlated (rs = 0.97) suggesting that they belong to the same substance. Sirius revealed that the top match for all MS2 spectra (100% for both HILIC and C18) was the bioTP PPL-OH-SO4  the identity suggested by CD was 3-(isopropylamino)-1,2-propanediol , Sirius suggested the PPL bioTP dihydroxyPPL as the 4th highest ranked suggestion for this feature. Moreover, FISh scoring successfully matched all 12 fragments  suggesting that the same substance was observed in both analyses, and possibly the presence of isomers in the case of the 2 features at 451.184 in C18. Sirius results further supported the hypothesis of conjugation, with 100% of submitted MS2 spectra for the mass at 451.184 matching hydroxypropranolol glucuronide (PPL-OH-glucu)  and 100% of submitted MS2 spectra for 435.189 (HILIC and C18) matching propranolol glucuronide (PPL-glucu). For the features at 435.189, a total of 23 fragments in HILIC  and 451.184 Da (HILIC + 2 features in C18) were suggested by CD to be glucuronidated phase 2 conjugates. For a given neutral mass, peak intensities obtained from C18 and HILIC were significantly and highly correlated  could not be confirmed as PPL bioTPs. MS2 spectra were not collected for the feature at 274.153, while for 396.172 Da, matches in Sirius were inconsistent and did not include PPL bioTPs amongst the plausible structural predictions. For 182.0729 the Sirius predictions did include a plausible in-source fragment of PPL, and the retention times of PPL and this feature overlapped. For 651.273 the CD- and Sirius-predicted formulas agreed, and Sirius predicted all 11 MS2 spectra as a complex molecular structure without any obvious connection to PPL (see Table S33.3−1 [n = 9] and 4600 μg L−1 [n = 8]) the RSDs of the 5 CL 1 identified bioTPs ranged from 21% (PPL-OH) to 109% (PPL-glucu in C18) across both HILIC and C18 datasets. Biotransformation capacity is known to vary significantly in humans, and has also been shown to vary in fish.48–50 Although the variation between individuals for some bioTPs in our data is considerable, the general profile of these compounds is comparable between embryos  but due to the observation of the former in the dosing medium and the latter as a  in-source fragment of PPL, we could not confirm these structures as bioTPs of PPL. Overall, this is the first time bioTPs have been measured in single ZF embryos, and shows the potential for bioTP screening in very small samples. Elucidation of bioTP formation can contribute to the weight of ecotoxicological findings. Moreover, the potential to screen for bioTPs and metabolomic response in the same dataset from the same individual, increases throughout, reduces costs, and may facilitate links between bioTPs and toxicometabolomic perturbations in the same individual.In this study a total of 7 confirmed PPL bioTPs were observed  and through contact with the corresponding author.All data used for this study are readily available through the Dryad Digital Repository (https://github.com/parasitetwin/ExpMetFilter) or through direct contact with the corresponding author.Code used for this study is available through GitHub (Anton Ribbenstedt: conceptualization, data curation, formal analysis, investigation, methodology, software, visualization, writing – original draft, writing – review & editing, Jonathan P. Benskin: conceptualization, formal analysis, project administration, supervision, validation, visualization, writing – original draft.There are no conflicts to declare.RA-011-D1RA01111A-s001RA-011-D1RA01111A-s002


Bile leaks were present in 10.1% (DCD-LTs), 7.2% (DBD-LTs), and 36.2% (LD-LTs) . AS developed in 28.3% DCD-LTs, 18.1% DBD-LTs, and 43.5% LD-LTs . NAS was present in 15.2% DCD-LTs, 1.4% DBDs-LT, and 4.3% LD-LTs . LTs w/o BC had better liver graft survival compared to any other groups with BC. DCD-LT and LD-LT had excellent graft survival despite significantly higher BC rates compared to DBD-LT. DCD-LT represents a valid alternative whose importance should increase further with machine/perfusion systems.Donation-after-circulatory-death (DCD), donation-after-brain-death (DBD), and living-donation (LD) are the three possible options for liver transplantation (LT), each with unique benefits and complication rates. We aimed to compare DCD-, DBD-, and LD-LT-specific graft survival and biliary complications (BC). We collected data on 138 DCD-, 3,027 DBD- and 318 LD-LTs adult recipients from a single center and analyzed patient/graft survival. BC (leak and anastomotic/non-anastomotic stricture (AS/NAS)) were analyzed in a subset of 414 patients. One-/five-year graft survival were 88.6%/70.0% for DCD-LT, 92.6%/79.9% for DBD-LT, and, 91.7%/82.9% for LD-LT. DCD-LTs had a 1.7-/1.3-fold adjusted risk of losing their graft compared to DBD-LT and LD-LT, respectively (  Graft survival in the three groups (n = 414) was further stratified by organ type and biliary complication occurrence (none versus any) (p = 0.018) (n = 10) are ultimately stent-free. LT recipients with NAS had worse graft survival compared to the NAS-free patients (p < 0.05). Patients with NAS had a median (IRQ) of 7 (5–10) ERCPs. We searched potential risk factors for any biliary complications in the matched/paired cohort (n = 414) , and LD recipients had more anastomotic strictures (43.5%) . Non-anasus any) . LD-LTs = 0.018) . Among tn = 414) . After mLiver transplantation using DCD or LD donors is limited to a minority of centers because of the higher rates of ischemic cholangiopathy (DCD-LTs) or biliary complications (DCD and LD-LTs) compared with grafts from DBD donors , 23, 27.We first observed and confirmed the known increased risk of graft loss (HR of 1.7) in recipients receiving DCD livers compared to those receiving DBD grafts, which matches with previously reported risk , 29, altThe nature and frequency of biliary complications are what differentiate most long-term outcomes in DCD-LT versus DBD-LT or LD-LT. A focused analysis led us to study biliary complications in 414 recipients, including one-third of each donor type. Non-anastomotic biliary stricture developed in 15.2% of DCD recipients, which aligns with what is reported in the literature , 8, 11. The development of NAS negatively affected graft survival; however, 50% of the patients with NAS ultimately kept their graft and remained stent free in the long term.Overall, given the reported 1- and 5-year graft survival rates and biliary complication rates, it seems that both DCD-LT and LD-LT are viable options when DBD grafts are limited or unavailable. Successful LD selection is well codified, and biliary complication rates vary between different centers . Similarex situ perfusion technologies will lead to a significant risk modification that is proportional to the costs and logistic difficulties of their use and/or if this risk modification can be achieved through better organ selection. Nevertheless, the choice of proceeding with an LD versus waiting for a DCD or a DBD graft to become available will remain a point of discussion globally and at the individual patient level.Our study has limitations. We report on a retrospective cohort; thus, information bias and selection bias cannot be totally avoided. It is noteworthy that the number of missing data was low, therefore limiting information bias. Another point is that our study extends over a large period ; therefore, we cannot totally exclude bias related to the evolution of surgical technique, donor/recipient selection practices, and recipient management policies. To account for this, we used “era” as an independent study variable in our multivariate analysis. Interestingly, era was significantly associated with graft survival but not with biliary complications. Moreover, the low number of DCDs and LDs and the fact that the evolution of techniques is a continuum prompted us to consider a larger study period. However, to limit its impact, we restricted the matched/paired analysis to the 2003–2019 period. Another limitation is that our conclusions are based on a single-center data analysis and should be confirmed in a multicenter cohort. From a broader perspective, it is also worth noting that the increasing use of machine perfusion devices for DCDs may change the rate and nature of complications in the future , 33–36. In conclusion, we exposed the differential incidence and effect of biliary complications on the outcomes after liver transplantation using brain-dead donors, donors after circulatory death, and living donors. We demonstrated that LD-LT achieved the best 1-and 5-year graft survival, and DCD-LT achieved excellent graft survival in the absence of biliary complications. DCD-LT is expected to become an equivalent alternative to DBD- and LD-LT given the further reduction of ischemia-reperfusion injury and biliary microcirculation damage offered by machine and regional perfusion systems.


Correction to: International Journal of Legal Medicine (2022) 136:1105–1111https://doi.org/10.1007/s00414-022-02814-0The online version contains an error in Author name. “G. G. Núñez Carrillo” should be changed to “G. G. Carrillo Núñez”.The original article has been corrected.


Prosopis cineraria (Fabaceae) is known as Khejri in India or the golden tree of Indian deserts. It’s potential as a dietary supplement in sports nutrition and its effect on regulating lipid profile has never been investigated. Spirulina (Arthrospira platensis) is a superfood with high nutritional value and is a popular supplement among athletes. In the current study, Spirulina and Khejri were used as supplements by cricket players to improve their physical fitness and lipid profile. Both supplements were given to individual groups and in combination to see the combined effect. The intervention period was 21 days, and supplements were given in 500 mg doses daily. Lipid profile assessments were done before and after the intervention period. 40 cricket players were divided into 4 groups: Group 1 (n = 10): Both supplements, Spirulina and Khejri, Group 2 (n = 10): Supplement Spirulina, Group 3 (n = 10): Supplement Khejri, and Group 4 (n = 10): Control. When experimental groups 1, 2 and 3 were compared to the control group 4, significant reduction was observed in triglyceride levels  and significant reduction in cholesterol levels was found post-intervention after 21 days of supplementation . Cholesterol and Triglyceride levels were significantly decreased pre- vs. post-intervention by Khejri and Spirulina supplements in cricket players. Cricket is an international sport, and cricket players maintain their physical fitness by following specific exercise training programs to meet the game's physiological demands and other performance requirements . DiffereHerbal supplements are becoming popular among athletes because of their rich nutritional profile and performance-enhancing potential . AthleteArthrospira platensis) is a popular supplement that is known for its high nutritional value. Ancient Aztecs used it as a protein-rich supplement in their diets. The recorded history of the consumption of microalgae dates back to the year 1521 when Bernal Diaz del Castillo described the consumption of a preparation of Spirulina by people in the vicinity of Mexico City. Due to its unmatched composition, it was declared as “best food for tomorrow” by United Nations at the world food conference in 1974 : Both supplements Spirulina and Khejri B, Group 2 (n = 10): Supplement Spirulina, Group 3 (n = 10): Supplement Khejri, and Group 4 (n = 10): Control. The inclusion criteria included healthy young, physically active cricket players involved in this study. The exclusion criteria included individuals with a cardiorespiratory disease or on medication. After using inclusion or exclusion criteria, overall, 40 samples were collected. A professional lab assistant collected blood. Blood samples (5 ml) for determining lipid profiles were obtained at rest. The blood was centrifuged at 3,000 rpm for 5 min at 4°C for serum separation. All of the biochemical tests have been done using serum samples. Lipid parameters  were measured using Arkray kits and a Biochemistry analyzer (RMS).In this research work, we conducted a comparative study of the effect of herbal supplementation on the physical fitness and lipid profile of cricket players. A total of 40 cricket players  participated in this study and were divided into 4 groups. Khejri and Spirulina were used as supplements by cricket players to improve their physical fitness and body composition. Dried pods of Khejri are known as Sangri and are the main part of Rajasthani cuisine. Both supplements were given to individual groups and in combination to see the combined effect of both supplements. The intervention period was 21 days, and supplements were given in 500 mg doses daily. Lipid profile assessments were done before and after the intervention period. 40 cricket players were divided in 4 groups: Group 1  for each variable. For the data collected in the current study, the mean value, standard deviation, standard error of mean, one way ANOVA and independent “Cricket players were invited to participate in a physical fitness test. They provided a consent form to fill in their general information, consent to use their data in this research, and agreement for their volunteer participation. Ethical approval for the study was obtained from the Ethics Committee, and informed consent forms were obtained from all players.p < 0.05. However, for triglyceride levels, the one-way ANOVA for comparison between treated groups was not found to be significant, p = 0.06. The results illustrate that the triglyceride level is significantly lowered post-intervention in Group 1 with Spirulina and Khejri combination supplementation . However, no significant difference was observed in cholesterol levels post-intervention in the same group  (p < 0.05) as well as cholesterol levels were reduced significantly post-intervention  (p < 0.05) and cholesterol levels  post-intervention in cricket players  as well as significant reduction in cholesterol levels was found post-intervention after 21 days of supplementation  (The data for comparing cholesterol and triglyceride levels pre and post-intervention with Spirulina and Khejri supplementation in cricket players are shown in  > 0.05) . In Grou < 0.01) . In Grou players . When al< 0.001) .This study aimed to study the effect of novel dietary supplement Khejri and Spirulina on cricket players’ lipid profiles. After the supplementation intervention period of 21 days, cholesterol and triglyceride levels reduced significantly compared to the control group and to pre-intervention levels for each Khejri and Spirulina supplementation when taken in combination. The observation that triglyceride and cholesterol levels decreased with Spirulina supplementation is in agreement with previous studies , 19. HowSince triglyceride and cholesterol levels are an essential measure of cardiovascular health , it is iIn conclusion, our data suggest that the dietary supplements Khejri and Spirulina confer a beneficial effect on the cardiovascular and overall health of cricket players. Appropriate nutrition is very important, along with regular exercise and training for the fitness of cricket players and better sports performance.The study's novelty is elaborated in the following points: (1) Khejri is a novel supplement that was never used earlier as a dietary supplement in sports nutrition. (2) Combination of Khejri and Spirulina is also a new addition to sports nutrition. (3) This is the first-ever study to report such intervention and its benefits for cricket players’ fitness and cardiovascular health.Cricket is one of the most popular sports in India. Identifying and establishing the health benefits and ergogenic efficacy of such herbal supplements for cricket players is extremely important. It can also be developed into a new herbal supplement with no harmful side effects.


According to the traditional Chinese zodiac, 2023 is the Year of the Rabbit, which holds the meaning of life and hope due to the rabbit's vigorous reproductive ability.AMEM has flourished, initial hopes have been realized and the journal has gone from strength to strength. Following the gradual rise in submissions and the journal's increasing influence, in 2022 AMEM changed from quarterly to bimonthly, and successively launched seven themed sections – columns – including neurodegenerative disease, cardiovascular disease, and so on. In the same year, it was included in the Scopus database, another milestone in the development of AMEM following inclusion in the DOAJ, PubMed Central, ESCI, and MEDLINE databases. In line with its remit of combining animal models and experimental medicine, AMEM publishes original articles, reviews, research highlights, reviews and other different types of articles on laboratory animals and animal experimental research to meet the needs of readers. As well as disseminating excellent achievements in experimental and translational medicine, the journal has always been committed to providing an international platform for reporting more valuable laboratory animal models.Over the past 5 years AMEM is the first international English‐language journal in China devoted to innovation and development of laboratory animal science and experimental medicine, including reporting on animal welfare and hot issues of concern to the Asian Federation of Laboratory Animal Science Associations. AMEM took the lead in publishing the Guidelines for Ethical Review of Laboratory Animal Welfare in China in 2020, demonstrating to the world the normativity and professionalism of animal experiments in China. As a journal with a sense of social responsibility, at a critical time with COVID‐19 raging around the world and endangering human health, the AMEM editorial team published the world's first research results from a rhesus monkey COVID‐19 model in the first issue in March 2020 (cited 174 times). AMEM has subsequently published a number of research papers on hot and difficult issues related to COVID‐19, including a column on the interaction between viruses and hosts in October 2022, allowing people around the world to see the research results of Chinese scientists.AMEM and we hope that the proportion of these articles will continue to increase in the future.As well as publishing work from China, AMEM also includes reports from Asia and the rest of the world. As the first English journal in the field of laboratory animal research in China, it shoulders the great responsibility of facilitating exchange, reference and complementarity between China and the world in many fields such as basic research on laboratory animals, breeding, welfare and ethics, transformation and application. We are pleased to see that more and more articles from international peers are being published in AMEM will move to a broader stage and become a well‐known and internationally renowned academic journal, a platform on which the world's outstanding scientists can display their achievements. I anticipate that AMEM will achieve more brilliant results in 2023 and wish everyone a happy new year!The prevention and control of COVID‐19 has entered the post‐epidemic stage and there will be much more scientific work of increasing importance to be completed in the future. In many areas of human diseases and research and development on drugs, there are still difficult problems that need to be solved. Animal models are an important part of laboratory animal science, and are widely used in experimental medicine for simulating human diseases. On the road to optimizing and innovating animal models and finding models closer to human diseases, scientists have never stopped exploring, and we are full of hope that we can meet new challenges. I sincerely hope that with the help of experts in the publishing industry and the editorial department,