Patients' experiences following total knee arthroplasty: a qualitative evidence synthesis.

PURPOSE: Total knee arthroplasty (TKA) is a common surgical intervention for patients with advanced arthritis. The aim of this qualitative evidence synthesis was to systematically review the qualitative literature on patients' experiences following primary TKA. MATERIALS AND METHODS: Four electronic databases (PubMed, CINAHL, Cochrane and Embase) were searched from inception until October 2021. Pairs of reviewers independently screened search results for eligibility, analysed the quality of included studies and extracted data. We undertook a thematic synthesis and used an interpretive approach to identify recurring themes and draw a conclusion. Data were synthesised using thematic analysis and an interpretive approach was used to identify themes. RESULTS: Twenty-three studies exploring patients' experiences following TKA were included. Five main themes emerged: (i) Experience of healthcare staff, (ii) Pain/Medications, (iii) Was it worth it? (iv) Social Support (v) Follow up. CONCLUSIONS: This review highlights the variability in patients' experiences following TKA. Whether this experience detailed their pain, function, or encounter with healthcare staff or systems, patients reported a variety of both positive and negative sentiments. Each theme invites attention to an area in which healthcare can improve to enhance patients' experiences. The importance of patient support, individualised rehabilitation and appropriate follow-up are highlighted.

This paper reviews patients' experiences after undergoing total knee arthroplasty (TKA)Patients need individualised programmes, made collaboratively with health care professionals, to maximise outcomes and improve motivation.Improved interdisciplinary dialogue and a more holistic approach would increase patients' confidence in their care.Group-based communication classes may offer an improved method for patients to communicate their worries and learn from one another.

Diatoms and Their Microbiomes in Complex and Changing Polar Oceans.

Diatoms, a key group of polar marine microbes, support highly productive ocean ecosystems. Like all life on earth, diatoms do not live in isolation, and they are therefore under constant biotic and abiotic pressures which directly influence their evolution through natural selection. Despite their importance in polar ecosystems, polar diatoms are understudied compared to temperate species. The observed rapid change in the polar climate, especially warming, has created increased research interest to discover the underlying causes and potential consequences on single species to entire ecosystems. Next-Generation Sequencing (NGS) technologies have greatly expanded our knowledge by revealing the molecular underpinnings of physiological adaptations to polar environmental conditions. Their genomes, transcriptomes, and proteomes together with the first eukaryotic meta-omics data of surface ocean polar microbiomes reflect the environmental pressures through adaptive responses such as the expansion of protein families over time as a consequence of selection. Polar regions and their microbiomes are inherently connected to climate cycles and their feedback loops. An integrated understanding built on "omics" resources centered around diatoms as key primary producers will enable us to reveal unifying concepts of microbial co-evolution and adaptation in polar oceans. This knowledge, which aims to relate past environmental changes to specific adaptations, will be required to improve climate prediction models for polar ecosystems because it provides a unifying framework of how interacting and co-evolving biological communities might respond to future environmental change.

Field cricket genome reveals the footprint of recent, abrupt adaptation in the wild.

Evolutionary adaptation is generally thought to occur through incremental mutational steps, but large mutational leaps can occur during its early stages. These are challenging to study in nature due to the difficulty of observing new genetic variants as they arise and spread, but characterizing their genomic dynamics is important for understanding factors favoring rapid adaptation. Here, we report genomic consequences of recent, adaptive song loss in a Hawaiian population of field crickets (Teleogryllus oceanicus). A discrete genetic variant, flatwing, appeared and spread approximately 15 years ago. Flatwing erases sound-producing veins on male wings. These silent flatwing males are protected from a lethal, eavesdropping parasitoid fly. We sequenced, assembled and annotated the cricket genome, produced a linkage map, and identified a flatwing quantitative trait locus covering a large region of the X chromosome. Gene expression profiling showed that flatwing is associated with extensive genome-wide effects on embryonic gene expression. We found that flatwing male crickets express feminized chemical pheromones. This male feminizing effect, on a different sexual signaling modality, is genetically associated with the flatwing genotype. Our findings suggest that the early stages of evolutionary adaptation to extreme pressures can be accompanied by greater genomic and phenotypic disruption than previously appreciated, and highlight how abrupt adaptation might involve suites of traits that arise through pleiotropy or genomic hitchhiking.

Neurovascular structures in human vastus lateralis muscle and the ideal biopsy site.

A density model of neurovascular structures was generated from 28 human vastus lateralis muscles isolated from embalmed cadavers. The intramuscular portion of arteries, veins, and nerves was dissected, traced on transparencies, and digitized before adjustment to an average muscle shape using Procrustes analysis to generate density distributions for the relative positions of these structures. The course of arteries, veins, and nerves was highly variable between individual muscles. Nevertheless, a zone of lower average neurovascular density was found between the tributaries from the lateral circumflex femoral and the deep femoral arteries. While the area with the lowest density was covered by the iliotibial tract and would therefore not be suitable for biopsies, another low-density area was located in the distal portion of vastus lateralis. This was just anterior to the iliotibial tract, in a zone that has been described as a good needle biopsy site. The reported complication rates of needle biopsies (0.1%-4%) are in the range of expectations when simulated based on this model. It is concluded that the optimal human vastus lateralis biopsy site is in the distal portion of the muscle, between ½ and ¾ of the length from the greater trochanter to the lateral epicondyle, just anterior to the iliotibial band.