Search Results (191)

Background and Objectives: Type 2 diabetes mellitus (T2DM) is associated with subclinical cardiovascular changes, such as increased arterial stiffness and myocardial dysfunction. Vitamin D deficiency has been recognized as a potential contributing factor to vascular disease; however, its impact on early cardiac changes associated with T2DM remains poorly understood. Our aim was to evaluate the association between serum levels of 25-hydroxyvitamin D3 [25(OH)D3], arterial stiffness, and left ventricular global longitudinal strain (LV GLS) in patients with T2DM who do not have a clinically evident cardiovascular disease. Material and methods: This cross-sectional study evaluated the carotid intima–media thickness (IMT), aortic pulse wave velocity (PWVao), LV GLS, and serum 25(OH)D3 levels in patients diagnosed with T2DM (n = 65) compared to healthy control subjects (n = 55). Independent predictors of arterial stiffness were identified by a multivariate logistic regression analysis. Results: Patients with T2DM showed a significant increase in IMT and PWVao, a reduction in LV GLS, and low levels of 25(OH)D3 compared to subjects in the control group (all p < 0.05). Both vitamin D deficiency and T2DM were found to be independently associated with an increased arterial stiffness, with odds ratios of 2.4 and 4.8, respectively. A significant inverse relationship was identified between 25(OH)D3 levels and markers of arterial stiffness, as well as LV GLS, suggesting a possible association between the vitamin D status and the early onset of cardiovascular dysfunction. Conclusions: Patients with T2DM show early signs of heart and blood vessel problems, even with an ejection fraction that remains within normal limits. There is a significant correlation between vitamin D deficiency and increased arterial stiffness, along with impaired LV GLS, indicating its possible involvement in cardiovascular complications associated with diabetes. These findings support the utility of integrating vascular, myocardial, and vitamin D assessments in early cardiovascular risk stratification for T2DM patients. Full article

Vitamin D deficiency is highly prevalent in individuals with overweight/obesity and this can be largely attributed to the entrapment of VitD in adipose tissue due to impaired lipolytic stimulation. Considering the well-described role of exercise in stimulating lipolysis, the present study investigated the efficacy of multicomponent-type high-intensity interval training (m-HIIT) in increasing 25-hydroxyvitamin D [25(OH)D] levels in males with overweight/obesity. Twenty middle-aged males (43.5 ± 5 years, BMI: 30.7 ± 3.3 kg/m²) participated in three weekly supervised m-HIIT sessions over a 12-week period and underwent assessments at baseline, 6, and 12 weeks. Primary outcomes were total body fat mass, android fat, hepatorenal index, and serum 25(OH)D. Participants’ daily physical activity and dietary intake habits remained unaltered throughout the 12-week training period. The m-HIIT intervention reduced fat mass (by 3% at 12 weeks), android fat (by 3.7% at 6 weeks and 4.4% at 12 weeks), and hepatorenal index (by 8% at 12 weeks). Serum 25(OH)D levels increased by ~14% (+3.21 ng/mL, p = 0.002) and ~31% (+7.24 ng/mL, p < 0.001) at 6 and 12 weeks, respectively. The elevation of 25(OH)D levels at 12 weeks was inversely related to fat mass loss (R = 0.53, p = 0.016). Plasma SGPT, SGOT, ALP, γ-GT, fetuin-A, and calcium levels remained unaltered after the 12-week training period. In conclusion, m-HIIT may be useful as a non-pharmacological intervention to increase circulating VitD levels in adults with overweight/obesity. Full article

Alkali-activated binders (AAB) are a suitable and sustainable alternative to ordinary Portland cement (OPC), with reductions in natural resource usage and environmental emissions in regions where the necessary industrial residues are available. Despite its potential, the lack of mix design methods still limits its applications. This paper proposes a systematic parametric validation for AAB mix design applied to pastes and concretes, valorizing steel slag as precursors. The composed binders are based on coal fly ash (FA) and Basic Oxygen Furnace (BOF) steel slag. These precursors were activated with sodium silicate (Na₂SiO₃) and sodium hydroxide (NaOH) alkaline solutions. A parametric investigation was performed on the mix design parameters, sweeping the (i) alkali content from 6% to 10%, (ii) silica modulus (SiO₂/Na₂O) from 0.75 to 1.75, and (iii) ash-to-slag ratios in the proportions of 75:25 and 50:50, using parametric intervals retrieved from the literature. These variations were analyzed using response surface methodology (RSM) to develop a mechanical model of the compressive strength of the hardened paste. Flowability, yield stress, and setting time were evaluated. Statistical analyses, ANOVA and the Duncan test, validated the model and identified interactions between variables. The concrete formulation design was based on aggregates packing analysis with different paste contents (from 32% up to 38.4%), aiming at self-compacting concrete (SCC) with slump flow class 1 (SF1). The influence of the curing condition was evaluated, varying with ambient and thermal conditions, at 25 °C and 65 °C, respectively, for the initial 24 h. The results showed that lower silica modulus (0.75) achieved the highest compressive strength at 80.1 MPa (28 d) for pastes compressive strength, densifying the composite matrix. The concrete application of the binder achieved SF1 fluidity, with 575 mm spread, 64.1 MPa of compressive strength, and 26.2 GPa of Young’s modulus in thermal cure conditions. These findings demonstrate the potential for developing sustainable high-performance materials based on parametric design of AAB formulations and mix design. Full article

Coronavirus disease 2019 (COVID-19) presents with various symptoms, and some patients develop post-COVID-19 condition (PCC). Vitamin D has shown therapeutic potential in COVID-19 and may offer benefits for PCC. The aim of this study was to evaluate the differences associated with two supplementation strategies (bolus and daily) on interleukin-6 (IL-6) levels, glutathione peroxidase (GPx) activity, and clinical outcomes in PCC patients, regardless of whether target 25 (OH) D levels reached the ideal range. We conducted a self-controlled study in which 54 participants with PCC were supplemented with vitamin D₃ (n = 28 bolus and n = 26 daily) for 2 months. Blood samples were collected to measure IL-6 levels and GPx activity using spectrophotometric methods. The Hospital Anxiety and Depression Scale (HADS) was used to assess mental function. Both bolus and daily vitamin D supplementation were significantly associated with increased GPx activity and decreased IL-6 levels. Daily supplementation was additionally associated with a significant reduction in anxiety and depression scores. However, neither regimen was associated with improvements in cough, dyspnea, or fatigue. These findings suggest a potential association between vitamin D supplementation and improvements in antioxidant and neuropsychiatric parameters in PCC, possibly mediated by its immunomodulatory and antioxidant properties. Further placebo-controlled trials are warranted to determine whether these observed associations reflect causal relationships. Full article

Suboptimal vitamin D status is commonly observed in primary hyperparathyroidism but is rarely considered in management decisions. The present study aimed to bring additional insights on vitamin D status in primary hyperparathyroidism patients, particularly those presenting with the normocalcemic phenotype. A retrospective study was conducted on 53 confirmed primary hyperparathyroidism patients, stratified into hypercalcemic and normocalcemic groups, hospitalized at the “Pius Brînzeu” Emergency Clinical Country Hospital in Timișoara, Romania. Patients presenting with the normocalcemic phenotype had similar target-organ involvement compared to their counterparts. In this subgroup, 25 hydroxyvitamin D showed an inverse correlation with serum calcium (p = 0.048), and regression analysis identified iPTH and 25OH vitamin D as significant predictors of calcium levels (p < 0.0001; $R^2$ = 0.571). Adenoma volume showed a significant negative correlation with 25OH vitamin D levels (p = 0.021; r = −0.61) but was later found as insignificant after confounder analysis. Postoperative measurements of 25OH vitamin D levels confirmed increasing levels after parathyroidectomy. Our findings highlight a complex relationship between PTH and vitamin D in primary hyperparathyroidism, especially in the often-underdiagnosed normocalcemic phenotype. The inverse correlation between vitamin D and calcium suggests altered homeostasis, rather than true deficiency. Full article

In both fundamental and applied scientific exploration, nanostructured protective materials have garnered substantial interest owing to their multifaceted utilization in the fields of medicine, pharmaceuticals, and electronics, among others. This study investigated the evolution of cutting-edge materials for electromagnetic radiation attenuation, with a specific emphasis on the incorporation of superparamagnetic magnetite nanoparticles, Fe₃O₄, into composite systems. The nanoparticles were generated through chemical condensation, meticulously adjusting the proportions of iron salts, specifically FeSO₄·7H₂O and FeCl₃·6H₂O, in conjunction with a 25% aqueous solution of ammonia, NH₄OH·H₂O. This study examined the intricate details of the crystalline structure, the precise composition of phases, and the intricate physicochemical attributes of these synthesized Fe₃O₄ nanoparticles. The analysis was conducted employing a suite of advanced techniques, including scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffraction (XRD), and energy-dispersive analysis (EDAX). The key findings of this research suggest that the magnetic nanoparticles generated through chemical condensation have an average size between 10 and 11 nm. This size was determined using BET surface area measurements, which were precise to within 0.1 nm. Moreover, this study demonstrated that incorporating superparamagnetic nanoparticles into composite materials significantly reduces microwave radiation. In particular, an optimal concentration of 0.25% by weight leads to a maximum decrease of 21.7 dB in cement specimens measuring 10 mm in thickness. Moreover, a critical threshold concentration of 0.5 weight percent is established, beyond which the interactions of nanoparticles inhibit the process of remagnetization. These investigations demonstrate that it is feasible to pursue a route towards the development of highly effective electromagnetic shielding materials tailored to specific requirements for diverse applications. Full article

Background and Objectives: Regular exercise is known to induce cardiovascular adaptations collectively referred to as “athlete’s heart”. While previous research has explored the morphological and functional cardiac adaptations in athletes, the relationship between vitamin D (25-hydroxyvitamin D [25(OH)D]) levels and echocardiographic parameters remains underexplored. This study aims to assess the association between 25(OH)D levels and structural and functional cardiac parameters using electrocardiographic (ECG) and echocardiographic evaluations in athletes. Materials and Methods: This case–control study included 93 male athletes, categorized into professional (n = 68) and recreational (n = 25) groups. Professional athletes were further divided into football (n = 19), weightlifting (n = 22), and running (n = 27) subgroups. Serum 25(OH)D levels were measured using high-performance liquid chromatography–tandem mass spectrometry (LC-MS/MS). Standard 12-lead ECG and transthoracic echocardiography were performed to assess cardiac structure and function. Data were analyzed using statistical tests that were appropriate for normal and non-normal distributions, with a significance level set at p < 0.05. Results: Athletes exhibited higher left ventricular interventricular septum (IVS) thickness and left ventricular posterior wall thickness (LVPWd) compared to the control group. Significant differences in diastolic function parameters, including early (E) and late (A) diastolic filling velocities and the E/A ratio, were observed among athlete subgroups. The weightlifting group showed lower end-systolic diameter (ESD) values than the football group. However, no statistically significant relationship was found between 25(OH)D levels and echocardiographic diastolic parameters. While more than half of the athletes had insufficient 25(OH)D levels (<30 ng/mL), their average values were higher than those reported in previous studies. Conclusions: This study demonstrates that 25(OH)D levels do not significantly influence echocardiographic diastolic parameters in athletes. However, notable differences in structural and functional cardiac findings were observed among different sports disciplines. These findings contribute to the understanding of cardiac adaptations in athletes and suggest that 25(OH)D may not play a crucial role in diastolic function. Further research is needed to explore the long-term effects of vitamin D on athletic cardiac performance. Full article

Vitamin D offers numerous under-recognized health benefits beyond its well-known role in musculoskeletal health. It is vital for extra-renal tissues, prenatal health, brain function, immunity, pregnancy, cancer prevention, and cardiovascular health. Existing guidelines issued by governmental and health organizations are bone-centric and largely overlook the abovementioned extra-skeletal benefits and optimal thresholds for vitamin D. In addition, they rely on randomized controlled trials (RCTs), which seldom show benefits due to high baseline 25-hydroxyvitamin D [25(OH)D] concentrations, moderate supplementation doses, and flawed study designs. This review emphasizes the findings from prospective cohort studies showing that higher 25(OH)D concentrations reduce the risks of major diseases and mortality, including pregnancy and birth outcomes. Serum concentrations > 30 ng/mL (75 nmol/L) significantly lower disease and mortality risks compared to <20 ng/mL. With 25% of the U.S. population and 60% of Central Europeans having levels <20 ng/mL, concentrations should be raised above 30 ng/mL. This is achievable through daily supplementation with 2000 IU/day (50 mcg/day) of vitamin D₃, which prevent diseases and deaths. Furthermore, a daily dose between 4000 and 6000 IU of vitamin D₃ to achieve serum 25(OH)D levels between 40 and 70 ng/mL would provide greater protection against many adverse health outcomes. Future guidelines and recommendations should integrate the findings from observational prospective cohort studies and well-designed RCTs to improve public health and personalized care. Full article

Background: Falls are a major public health concern. Daily vitamin D supplementation is a proposed fall prevention strategy; however, safety concerns have arisen from some clinical trials showing increased fall risk when using higher vitamin D dosing methods. The relationship between vitamin D and falls may be influenced by factors, such as inflammation, which can alter the balance of essential nutrients like vitamin D and retinol, potentially affecting motor function. We use a genetic epidemiological approach to explore the association of inflammation, vitamin D, and fall risk. Methods: We included 307,082 UK Biobank participants and conducted observational and Mendelian randomization (MR) analyses to investigate associations between 25-hydroxyvitamin D [25(OH)D] and fall risk, with analyses including restriction to participants who had fallen and had inflammation as defined by CRP ≥ 5 mg/L. Results: In the observational analysis, CRP was associated with a higher (per 5 mg/L CRP increase OR = 1.06, 95% CI 1.05–1.07) and 25(OH)D with a lower odds of falls. The association between 25(OH)D concentrations and fall risk was non-linear (p < 0.001), reflecting a plateauing of the association at higher concentrations. There was an interaction between 25(OH)D and CRP on their association with the odds of falls (p = 0.009). In participants with CRP ≥ 5 mg/L, the association was U-shaped, and the fall risk was elevated for both 25(OH)D < 25 nmol/L and ≥ 100 nmol/L (p < 0.004). The association between high 25(OH)D and falls was most pronounced for participants with CRP ≥ 20 mg/L (≥ 100 nmol/L vs. 50–74.99 nmol/L: OR = 2.40, 95% CI, 1.50–3.86). Genetically predicted higher 25(OH)D was not associated with fall risk in the overall population, but a suggestive association with fall risk was seen in participants who had fallen and had CRP > 20 mg/L (926 cases; OR = 1.20, 95% CI, 1.00–1.44). Conclusions: Our study suggests that inflammation might modify the vitamin D and fall risk relationship. Both low and high 25(OH)D levels are associated with more falls in individuals with chronic inflammation, with supporting evidence seen in both observational and MR analyses. This may provide insight into the increased fall risk following high-dose vitamin D supplementation in clinical trials, warranting further research. Full article

Background/Objectives: To collect evidence from studies that explored the associations between serum vitamin D (25[OH]D) concentrations/status and the presence of depressive/anxiety symptoms in the ante- and/or postnatal periods (PROSPERO-CRD42023390895). Methods: Studies that assessed serum 25[OH]D concentrations in adult women during the ante/postnatal periods and those that used valid instruments to identify the experience/severity of depressive/anxiety symptoms were included. Independent researchers performed the identification/selection of studies, data extraction, risk of bias (RoB) assessment, and bibliometric analysis steps. Results: Of the total of 6769 eligible records, 15 cohort studies [high (n = 3), moderate (n = 7), and low (n = 5) RoB], nine cross-sectional studies [moderate (n = 3) and low (n = 6) RoB], and one case-control study [moderate RoB] were included (n = 25). Depression (n = 24) and anxiety (n = 4) symptoms were assessed. A significant difference in antenatal serum 25[OH]D concentrations between the groups of women with and without depression was identified (mean difference: −4.63 ng/mL; 95% confidence interval [95% CI]: −8.88; −0.38). Postnatal serum 25[OH]D concentrations were found to be, on average, −2.36 ng/mL (95% CI: −4.59; −0.14) lower in women with postnatal depression than in those without. Maternal antenatal anxiety was associated with significantly lower concentrations/deficiency of 25[OH]D in only one included study. Conclusions: Based on very low/low-quality evidence, it was observed that reduced serum 25[OH]D concentrations in the ante- and postnatal period are associated with the presence of ante- and postnatal depressive symptoms, respectively. Low/deficient antenatal serum 25[OH]D concentrations may not be related to the presence of anxiety symptoms before childbirth. Well-designed longitudinal studies are needed to explore the estimated pooled effect of these associations. Full article

Background/Objectives: Young women are often at risk of vitamin D deficiency, while fatty fish can provide significant amounts of it, which is especially important when no vitamin D skin synthesis is possible due to limited sunshine exposure. This study aimed to analyze the impact of increasing the intake of salmon in various forms (smoked salmon, salmon sausages) on vitamin D status of young women in autumn. Methods: The 8-week intervention involved 120 non-obese women, aged 20–25 years. Participants were randomly assigned to one of three groups: smoked salmon (25 g/day), salmon sausage (100 g/day), or a control group. Both intervention products provided approximately 5 µg of vitamin D daily. Serum concentrations of 25(OH)D as well as vitamin D intakes were assessed pre-, mid-, and post-intervention. Results: The median vitamin D intake at baseline was 2.7–3.4 µg/day and did not differ between the groups (p > 0.05), while during the intervention, it was highest in the smoked salmon group (p < 0.001) and amounted to 7.3 µg/day. While all groups experienced a decrease in 25(OH)D serum concentrations, the decrease was significantly smaller in the salmon sausage group compared to the control group (−4.3 vs. −15.0 nmol/L, p < 0.05), and no significant difference was observed between the smoked salmon and control group after 8 weeks (p > 0.05). Moreover, in the salmon sausage group, the intervention was more effective among participants with an inadequate vitamin D status at baseline (25(OH)D change after the intervention: −3.0 vs. −5.4 nmol/L, p < 0.05; inadequate vs. adequate baseline vitamin D status). Conclusions: Increasing the intake of salmon, and hence of vitamin D, was not enough to maintain the vitamin D status of young women in autumn. It seems that other, not-yet-fully-understood factors, may influence vitamin D absorption and/or metabolism, thereby affecting the outcomes of such interventions indicating that further research is needed. Nevertheless, it may be concluded that increasing salmon sausage intake might aid slow down the natural decline of 25(OH)D in young women in autumn. Full article

In this prospective blinded study, canine C-reactive protein (c-CRP), haptoglobin (HPT), and 25-hydroxyvitamin-D (25(OH)D) were investigated for their diagnostic value in 55 dogs with nasal cavity disease (ND). After comprehensive diagnostics including a culture-dependent microbiological examination (ME) of nasal swabs, 17 dogs were excluded due to additionally detected systemic diseases or steroid pre-treatment. Included were 25 dogs with malignant ND (13 carcinomas and 12 sarcomas) and 30 dogs with benign ND (7 benign tumors, 13 idiopathic rhinitis (IR), and 10 others), as well as 10 controls. In none of the 72 dogs with ND was primary bacterial rhinitis diagnosed. Although within the reference interval, compared to the controls, c-CRP was significantly higher in dogs with ND in general and in every subgroup except for benign tumors. Serum HPT concentrations were not different among groups. Compared to the controls, 25(OH)D concentrations were significantly lower (p = 0.041) in malignant ND and sarcomas (p = 0.025). Despite pre-treatment with antibiotics (40/54; 74.1%), in 23/51 (45%) dogs, the ME was positive. Cultivated bacteria did not differ significantly between nasal diseases. The serum markers were not significantly different regarding the positivity of ME. In conclusion, the investigated serum markers were not clinically useful for the reliable detection of canine ND, as was the ME. Because of the low number of dogs with IR and positive or negative ME, further studies regarding c-CRP are needed in a larger group of IR dogs without concomitant diseases to reliably evaluate its utility in IR dogs with suspected secondary bacterial nasal infection. Full article

Introduction: Acute severe ulcerative colitis (ASUC) represents a life-threatening medical emergency. One-third of ASUC patients are steroid non-responders. Our study aimed to create a new ASUC algorithm to predict corticosteroid response in the early course of the disease. Materials and Methods: A cross-sectional study included 103 patients with ASUC (65 male, 38 female). We calculated the serum CRP to 25-hydroxy 25 OH vitamin D ratio at admission. Logistic regression determined patients’ response to glucocorticoids, depending on the CRP/25 OH vitamin D ratio value. Results and Discussion: Significant differences were observed in the CRP/25 OH vitamin D ratio at admission between glucocorticoid responders and non-responders (p = 0.001). A negative correlation was found between glucocorticoid response and CRP/25 OH vitamin D levels (Spearman’s rho = −0.338, p < 0.01). Logistic regression revealed a significant association (p = 0.003) with a model chi-square value of 11.131 (p = 0.001). ROC curve analysis showed an AUC of 0.696 (p = 0.001), indicating moderate discriminatory ability. To achieve 91% sensitivity, the CRP/25 OH vitamin D ratio must be less than 3.985 to predict a complete glucocorticoid response. Conclusions: The serum CRP to 25 OH vitamin D ratio on the first day of hospital admission can potentially determine the response to glucocorticoids in patients with ASUC and significantly affect the mortality of these patients. Full article

Background: Antiseizure medications (ASMs) are crucial for managing epilepsy in children. However, a well-documented side effect of ASMs is their impact on bone health, often due to interference with vitamin D metabolism. This can lead to vitamin D deficiency in children with epilepsy. This study aimed to determine if a daily dose of 400 IU or 1000 IU would maintain adequate vitamin D levels in children with epilepsy. Methods: A phase IV randomized controlled trial enrolled children aged 2–16 years with epilepsy and receiving antiseizure medications. Children were divided into two groups: the monotherapy group, which was defined as children on one antiseizure medication (ASM), and the polytherapy group, which was defined as children receiving two or more ASMs. Eligible children with levels above 75 nmol/L were randomized to receive a maintenance dose of either 400 IU/day or 1000 IU/day of cholecalciferol. Baseline and 6-month assessments included demographic data, anthropometric measurements, seizure type, medications, seizure control, and 25(OH)D level. Results: Out of 163 children, 90 were on monotherapy and 25 on polytherapy. After 6 months of vitamin D maintenance, the proportion of children with 25(OH)D concentration below 75 nmol/L was 75.0% in the 400 IU group and 54.8% in the 1000 IU group. In the monotherapy group, baseline seizure-free children increased from 69% to 83.6% after treating vitamin D deficiency. Conclusion: Daily vitamin D supplementation with 1000 IU may be beneficial for children with epilepsy, particularly those receiving monotherapy, to maintain sufficiency and potentially improve seizure control. Full article

Vitamin D is crucial for ideal bone health and good muscle function, both essential requirements for successful joint arthroplasty. Hence, vitamin D deficiency has recently been identified as a predictor of poorer outcomes in patients scheduled to undergo total joint arthroplasty (TJA). Moreover, there is ample evidence today that vitamin D deficiency is associated with periprosthetic joint infection. Yet, vitamin D deficiency seems to be frequent in patients who are scheduled to undergo TJA. However, the prevalence of hypovitaminosis D in patients who require revision arthroplasty (rTJA) is largely unknown. Further, risk factors of vitamin D deficiency in these patients remain to be elucidated. For this reason, the primary objective of this study was to assess the vitamin D status of patients scheduled to undergo rTJA of the hip, knee and shoulder. The secondary objective was to identify potential risk factors for hypovitaminosis D in these patients. Serum vitamin D [25(OH)D] levels of 249 patients who were scheduled for rTJA were assessed over a period of twelve months at a high-volume TJA centre. Collectively, 23% of patients reported a routine intake of vitamin D supplements (58/249). Notably, 81% of patients (155/191) who did not report a routine vitamin D intake presented with insufficient vitamin D levels (below 30 ng/mL), while only 19% of patients (36/191) had sufficient vitamin D levels. Of those who reported a routine vitamin D intake, 75% (43/58) had sufficient vitamin D levels, while 25% (15/58) showed insufficient vitamin D status. Patients who did not routinely take any vitamin D supplements had significantly lower vitamin D levels compared to patients who reported regular vitamin D intake (19.91 ng/mL vs. 40.66 ng/mL). Further, BMI and nicotine abuse were identified as potential risk factors for hypovitaminosis D in patients without vitamin D supplementation. Moreover, the season of spring seems to be a risk factor in patients with vitamin D supplementation, while age itself did not appear to be a significant risk factor for low vitamin D levels. In conclusion, we found an alarmingly high rate of vitamin D deficiency in patients scheduled to undergo rTJA. Notably, reported routine vitamin D supplementation showed significantly increased serum vitamin D levels compared to patients with no reported supplementation. Due to the high prevalence of vitamin D deficiency, we believe that vitamin D status should routinely be assessed in patients who are scheduled to undergo rTJA. Full article