I am lucky in that the two teams I follow most closely—the New York Mets and Michigan football—have very strong blog communities. I reached out to seven prominent Michigan football bloggers to get their takes on the Wolverines now that, just like 2009, the team is 4-0. Below are lightly edited (and, in some cases, abridged) versions of many of the responses.
Before the season started, you predicted a X-X record. Given the 4-0 start, is it fair to adjust that expectation? (Blogger’s preseason prediction, if one was made, appears before their answer.)
Greg Dooley, MVictors: (6-6) It’s definitely fair to adjust preseason expectations after watching Denard through four games. I didn’t expect us to get through both UConn and Notre Dame unscathed. But I’m really not convinced that the defense will pull them them through the Big Ten schedule.
Brian Cook, MGoBlog: (7-5) Yes, for a couple of reasons. They won two games that were considered coin flips (or thereabouts) before the season, so that’s a game right there. And then Denard is probably worth another game even accounting for the goofy defense. I’m now on the 9-3/8-4 borderline.
Dave Nightingale, Maize n Brew: (7-5) Honestly, no. I fluctuated between and 8-4/7-5 record because of Michigan’s defense, not because of the performance on offense. Going into the game against Indiana, I’m petrified of the Hoosier’s offense and our ability to defend it. When you’re dead last in pass defense and eighth in rush defense (in the Big Ten) going into conference play, I’m not so sure it’s prudent to start dreaming big.
Bob Agno, Big House Blog: (7-5) Yes you can. Before the season we had two big question marks: How would the defense hold up and who would be Michigan’s QB? I still think there are a number of questions on defense, but the offense is much more explosive than I expected. I expect Michigan to go 8-4 with the high still 9-3. The big test will be to see how Michigan plays against a defense like Iowa’s on October 16.
Chris Gaerig, Burgeoning Wolverine Star: (8-4) I think Michigan has a chance to win nine games this year. Every game aside from Wisconsin and Ohio State at the end of the year looks winnable and in several of them, Michigan should be the favorite. The 2-0 start was critical and gives them a bit of leeway for the eventual defensive apocalypse that will cost them a game against a Big Ten bottom feeder.
Lance Callihan, UMGoBlog: Before the season, I said we could beat or lose to anyone, yet I didn’t have much hope against Wisconsin or Ohio State. Now, anything truly can happen.
Brad Muckenthaler, Maize and Blue Nation: I guess I sort of predicted seven or eight wins, but I never picked individual games. After four weeks, and four wins, I don’t feel any need to adjust that prediction. The Big Ten season is a whole different animal, and anything can happen.
How much does last year’s 4-0 start and subsequent collapse affect how you look at this year’s team?
Dooley: It’s a heavy weight for me. I think we’ll know after the Michigan State game whether this defense can hang.
Cook: Not much. The 2009 team was getting outgained (yardage-wise) and still winning; this team has a huge yardage advantage.
Nightingale: Remembering just how bad Michigan’s been on defense the last three years (this year included) is what keeps my expectations grounded. Last season, more than anything, taught me not to overlook obvious flaws in a team just because you root for them.
|Who doesn’t like watching Denard Robinson play football?|
Agno: I think the offense is more explosive than it was in 2009. Even with Michigan’s fast start last year you saw the offense sputter at times. This year, Michigan’s offense has been consistently been moving the ball. It’s hard to say that the Michigan defense is better in 2010 without Brandon Graham, Donovan Warren, and Troy Woolfolk, but this defense seems to be playing smarter through four games. The other positive is that Michigan already has a road win this year. With that said, the collapse in 2009 is still fresh in everyone’s minds. Fans will hold their collective breath until Michigan has qualified for a Bowl game.
Gaerig: It’s hard to shake the feeling of last year’s team especially with the defensive collapse against UMass. Whether or not Michigan can win against the more potent offenses of the Big Ten (Michigan State, Wisconsin, Iowa, Indiana) is going to be the question.
Callihan: The differences between last year and this year are huge. This year the offense comes at you in waves, while last year there was no depth.
Muckenthaler: This team is its own team. I look at this team, especially the offense, as the beginning of what a Rich Rodriguez-led Michigan team should be. I think 2009 taught this team, and its fans, to take the season one week at a time. We got a little ahead of ourselves last year thinking we were better than we really were. Those lessons are still fresh in the mind of this year’s team. I don’t think early success this year has clouded our memories. This team seems to be as focused as ever.
Is there anything about this team that leads you to believe it will avoid the fate of the 2009 squad?
Dooley: The offense is better almost top to bottom. Kicking and punting are way down and will cost us at least one game. The defensive line is a push, the linebackers are maybe slightly improved, the secondary is worse but holding up. All told the team is at least slightly better, with the X-factor being Denard who’s obviously off the charts. If Denard is healthy Michigan is better and should win more games.
Cook: Yardage. Non-freshman quarterbacks. An offense that can do all kinds of stuff.
Nightingale: Offensive depth. Last season our offense was paper thin and injuries completely destroyed its production. Flash forward to 2010: Michigan has actual depth on the offensive line. I can’t name a deeper receiving corps than Michigan’s right now in the Big Ten. At tailback, Michigan has five guys capable of carrying the mail. Relying on an offense to outscore everyone is a dangerous proposition, but against the lower tier of the Big Ten it will garner some wins that were close losses last season. But without continued improvement from Michigan’s linebackers and a pass rush, their margin for error is pretty slim.
Agno: Yes, the defense seems to be better coached with another year under Greg Robinson. On the other side of the ball, it’s clear that as long as Denard stays healthy Michigan will have a chance to win every game they play. I also believe Tate Forcier will win at least one game for Michigan this year.
|The bloggers aren’t as high on the defense, which has allowed too many of these (touchdowns).|
Gaerig: Aside from Denard, no. The defense is still barren, the offense lacks true playmakers, and the schedule is arguably more difficult this year than it was last year. Michigan is going to be in a fight in a lot of these games, and winning them will depend largely on the turnover battle. Though I think 7-5 or 8-4 is more likely, I wouldn’t be at all surprised by a 5-7 or 6-6 result.
Callihan: Offensive depth. The offense needs to be the strength of this time and it will be. I’ve told people for the last two seasons to stop hoping for the defense to bail out this team. Having the defense lead the way goes against Rich Rodriguez’s philosophy.
Muckenthaler: We have a few things going for us this year that we didn’t have a year ago, like perhaps the most explosive and talented offensive player in the country. But I think the biggest thing is depth on offense. This offense thrives on lots of backs and lots of receivers. That style has created depth at those positions that Michigan has never had before. We’re going to be able to hang with anyone we play this year. That’s something that we didn’t know four weeks ago.
So what can we conclude? First of all, bloggers are smart. Nobody said, “4-0 BABY! BRING ON ALABAMA!! DENARD 4 HEISMAN!!1” In fact, the reactions were far less optimistic than I would have thought. Even for those who claim 2009 means relatively little, I have to imagine it’s fresh in their minds given their cautiousness.
A constant in nearly all responses was offensive depth. An injury to any starter—particularly on defense—would be terrible, but last year it was crippling and was a main factor in the collapse. This year it will take a lot more adversity to prevent Michigan from getting to seven wins.


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For many of those lucky enough to be able to stay home during the coronavirus pandemic, books have taken on a special meaning. COVID-19 book clubs have popped up to help readers feel connected to one another, group readings have brought new life to old poems, and—in this time of ambient anxiety—the value of losing yourself in a novel has never seemed more apparent. What follows is a selection of recommendations from The Atlantic’s culture writers and editors, with an eye toward stories that will resonate during a summer of continued social distancing and tentative reopenings. We’ve loosely grouped them according to literary cravings you might have: Perhaps you’ll decide on a breezy beach read to devour responsibly on your fire escape or a collection of nature essays that lets you explore the outdoors from your living room. Either way, stay safe, and happy reading.
IF YOU WANT TO GET LOST IN A PLACE
Wilderness Essays, by John Muir
For the past several years, my family has spent our summer vacations exploring America’s national parks. Acadia, Glacier, Badlands, Grand Teton, Yellowstone—they’re places as humbling as they are astounding, and our goal is to visit each one, eventually. When we canceled this year’s trip (hope to see you soon, Zion), I found some consolation in the writings of John Muir. And because the naturalist turned activist was so prolific—many of his writings were originally published in The Atlantic—I’ve been loving Wilderness Essays, a collection of the work he produced as he explored the western United States in the late-19th and early-20th centuries. Muir had the eye of a scientist and the wonder of an enthusiast; in his observations, run-on sentences spill forth in adjectival ecstasies (“the vast forests feeding on the drenching sunbeams, every cell in a whirl of enjoyment”), nature transforms from a place into a character, and the whole tumult resolves in giddy benedictions. “Climb the mountains and get their good tidings,” Muir urges. “Nature’s peace will flow into you as sunshine flows into trees.” — Megan Garber

domain: literature


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After knee arthroplasty (KA) surgery, patients experience abnormal kinematics and kinetics during numerous activities of daily living. Biomechanical investigations have focused primarily on level walking, whereas walking on sloped surfaces, which is stated to affect knee kinematics and kinetics considerably, has been neglected to this day. This study aimed to analyze over-ground walking on level and sloped surfaces with a special focus on transverse and frontal plane knee kinematics and kinetics in patients with KA. A three-dimensional (3D) motion analysis was performed by means of optoelectronic stereophogrammetry 1.8 ± 0.4 years following total knee arthroplasty (TKA) and unicompartmental arthroplasty surgery (UKA). AnyBody™ Modeling System was used to conduct inverse dynamics. The TKA group negotiated the decline walking task with reduced peak knee internal rotation angles compared with a healthy control group (CG). First-peak knee adduction moments were diminished by 27% (TKA group) and 22% (UKA group) compared with the CG during decline walking. No significant differences were detected between the TKA and UKA groups, regardless of the locomotion task. Decline walking exposed apparently more abnormal knee frontal and transverse plane adjustments in KA patients than level walking compared with the CG. Hence, walking on sloped surfaces should be included in further motion analysis studies investigating KA patients in order to detect potential deficits that might be not obvious during level walking.
Citation: Komnik I, Peters M, Funken J, David S, Weiss S, Potthast W (2016) Non-Sagittal Knee Joint Kinematics and Kinetics during Gait on Level and Sloped Grounds with Unicompartmental and Total Knee Arthroplasty Patients. PLoS ONE 11(12): e0168566. https://doi.org/10.1371/journal.pone.0168566
Editor: John Leicester Williams, University of Memphis, UNITED STATES
Received: July 31, 2016; Accepted: December 4, 2016; Published: December 21, 2016
Copyright: © 2016 Komnik et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Due to the data protection policy of the German University, raw data of the current study are not available in the manuscript, supplemental files or in a public repository. In order to request raw data, readers can contact the corresponding author, Igor Komnik. All relevant data are within the paper.
Funding: The study was supported by ARCUS Clinics Pforzheim. All knee arthroplasty subjects, who participated in the current study, were operated in the mentioned institution. ARCUS Clinics Pforzheim provided support in the form of salary for the author SW, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of SW are articulated in the “author contributions” section. The graduate college of the German Sport University funded the PhD studies for the corresponding author IK in the form of salary (http://www.dshskoeln.de/visitenkarte/einrichtung/graduiertenkolleg-mechanobiologie/). The funder did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. "Verein für Wissenschaft und Weiterbildung in der Orthopädie e.V." (English: “Science and Advanced Training Society in the field of orthopedics”) funded the knee arthroplasty subject’s accommodation and travel costs to Cologne (http://www.sportklinik.de/wissenschaft_publikation/). The funder did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The study was supported by ARCUS Clinics Pforzheim. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The authors have declared that no competing interests exist.
In recent years, studies in the field of KA research have shown abnormal gait characteristics during various activities of daily living (ADL)[1–3]. However, previous authors primarily investigated level walking in patients after TKA surgery, revealing reduced knee flexion excursion and knee flexion moment during the loading response phase compared with healthy controls [4,5]. Physically more demanding ADL, such as stair climbing tasks, showed inconsistent results in terms of kinematics and kinetics due to methodological flaws . In general, biomechanical analysis of physically more demanding ADL, other than level walking, has been addressed less often in the previous literature. In this regard, there are no motion analysis studies to this day investigating KA patients negotiating sloped surfaces . These kinds of daily barriers are common in urban areas and pose a challenge to the musculoskeletal system. Healthy subjects show more ankle, knee and hip joint flexion during incline walking compared with level walking, whereby greater demands occur in the hip [8–10]. On the other hand, movement adjustments occur particularly at the knee joint during decline walking, revealing increased eccentric knee extensor activity accompanied by enhanced mechanical power requirement in the stance phase [10,11]. Furthermore, declined surfaces increase the risk of slips and falls . Hence, ramp negotiation could expose potential gait deficits which are more apparent and meaningful than during level walking in patients after KA surgery. This could be of great importance for the evaluation of KA patients’ rehabilitative progress.
However, besides the locomotion task, different types of prosthesis designs are considered to have a significant effect on patients’ knee kinematics and kinetics. Andriacchi et al.  emphasized the importance of cruciate ligament preservation in TKA which plays a major role concerning proprioceptive joint control. UKA assumes the preservation of both cruciate ligaments whereby, in contrast to TKA, only medial or lateral femur and tibia compartments are replaced. Several in vitro and in vivo studies based on fluoroscopic investigations reported that UKA succeeds at restoring normal joint kinematics during kneeling tasks [13–15]. Preservation of the anterior cruciate ligament (ACL), however, seems to be a major reason for the normal movement pattern of the replaced condyles. Further potential reasons for normal knee kinematics and kinetics in UKA patients, such as the preservation of the lateral knee compartment or different bearing shapes compared with TKA, should be considered. Addressing the question of whether UKA is able to restore normal knee mechanics compared with TKA, UKA patients in a study by Jung et al.  performed stair climbing with similar knee internal rotation in their operated knee to the non-operated knee (non-OP knee) in contrast to TKA patients. A recent study  used a machine learning approach to classify and identify UKA and TKA knees on the basis of recognized patterns. When applied to healthy controls their decision tree algorithm classified 92% of the healthy controls as being UKA subjects, revealing a more physiological gait than TKA subjects.
There has been a rising popularity of UKA in recent years and the aspect of a more natural gait pattern has contributed to this popularity. Nevertheless, UKA still represents a small proportion (8%) of all performed KAs . Interestingly, studies have reported that 36%–48% of all candidates fulfill the criteria for UKA [19,20]. The potential functional benefit of UKA has not been studied sufficiently by means of comprehensive motion analysis, particularly under the consideration of physically more demanding ADL and inclusion of TKA and UKA groups as well as healthy controls . A better understanding is necessary for better patient-specific preoperative planning in daily clinical practice and could provide decision support regarding the appropriate treatment.
Additionally, in the field of KA previous biomechanical studies have primarily focused on sagittal plane parameters. Frontal plane and particularly transverse plane kinematics and kinetics have by and large been neglected, although the clinical relevance of forces and moments acting in these planes was highlighted, especially in the field of osteoarthritis [21,22]. In this regard, studies clarified that knee adduction and internal rotation moments are significant discriminatory factors of osteoarthritic gait pattern. Furthermore, it has been shown that patients with ACL-deficient knees reveal abnormal tibial rotation in the transverse plane during gait and highly functionally demanding tasks, as the ACL restrains the tibia’s anterior-posterior translation, but also its internal rotation [23–25]. Moreover, aseptic loosening of prosthesis components remains, among others, the leading reason for failure [26,27]. In this regard, mechanical aspects, such as torsional micromotion contributing to component loosening, have not yet been adequately explained . Investigation of transverse plane mechanics might provide better insight into factors leading to KA failure. Therefore, non-sagittal plane knee kinematics and kinetics are of particular interest concerning the influence of different locomotion tasks and prosthetic design.
The purpose of this retrospective case control study was to analyze knee kinematics and kinetics of patients with TKA and UKA with a special focus on the frontal and transverse plane during level, incline and decline walking compared with a healthy CG. The first hypothesis was that the UKA group would reveal more similar knee mechanics to the CG than to the TKA group. The second hypothesis was that decline walking in particular exposes greater abnormal kinematics and kinetics in the knee joint compared with level and incline walking in either KA group.
Ethical approval for the current study was granted by The Ethics Committee of the German Sport University (ethical proposal no. 025/2014). All subjects signed a written informed consent form according to The Declaration of Helsinki.
Thirty-seven subjects participated in the current study. All patients who underwent primary unilateral UKA and TKA for knee degenerative osteoarthritis were recruited from ARCUS Clinics Pforzheim (Germany). Initially, 210 TKA and 83 UKA patients were assessed for eligibility. Forty-nine subjects consented to participate in the current study. After a telephone interview 25 subjects had to be excluded. Ultimately, eleven patients formed the TKA-group and 13 subjects represented the UKA group. A healthy age matched CG consisted of 13 subjects who reported no knee pain and functional impairments for a period of one year prior to testing. Exclusion criteria were (1) further joint arthroplasties, (2) musculoskeletal impairments that affected ADL, (3) pain or functional impairment in the non-OP knee, (4) body mass index (BMI) greater than 31 kg/m2, (5) cardiovascular disease, (6) neurological disorders, (7) diabetes mellitus, (8) rheumatic diseases, limb-valgus deformity greater than 7° and limb-varus deformity greater than 4° and (9) knee flexion contracture greater than 5°. All UKA patients received a medial cemented endoprosthesis (Unicompartmental High Flex Knee System, Zimmer, Warsaw, USA). Seven TKA patients received a cemented posterior stabilized endoprosthesis (SIGMA, DePuySynthes, Warsaw, USA) and four patients received a cemented posterior cruciate ligament preserved endoprosthesis (Genesis II, Smith and Nephew, Memphis, USA). A minimally invasive approach was used in all UKA patients and a standard medial parapatellar approach in all TKA patients. Gait analysis was performed on average 1.8 ± 0.4 years post-surgery.
Gait analysis was performed by means of a 3D, 10-camera (100 Hz) motion analysis system (VICON MX40, Vicon Motion Systems Ltd, UK). Simultaneously, ground reaction forces were collected at 1000 Hz using three Kistler force plates (KistlerInstrumente AG, CH). Two force plates were embedded in the floor and one under a three-step ramp (gradient: 21%). In order to create a lower-limb model consisting of nine rigid segments, 28 spherical, retroreflective markers were attached bilaterally to the anterior and posterior superior iliac spines, greater trochanters, lateral and medial condyles of the femurs, tibias, lateral and medial malleoli, heads of the first and fifth metatarsals, second proximal phalanges, lateral, medial and backside of the calcanei. Data collection started with a standing reference trial. Subsequently, the CG, which was tested before both KA groups, practiced level walking on a 15-m walkway. The captured valid trials were within 5% deviation of the practiced speed. After several practice trials TKA and UKA subjects performed the level walking task at the CG’s comfortable average gait velocity of 1.4 m/s ± 5%. Following level walking, all subjects performed incline or decline walking tasks respectively. The order was randomly chosen by the examiners. In order to avoid impairments of subjects' habitual gait pattern, all subjects were asked to negotiate incline and decline walking at their comfortable speed. Gait velocity was measured by means of a time-gate system (WEKO, Weitmann & Konrad GmbH & Co KG., DE) and subsequently calculated by means of the center of mass (CoM) course. A trial was valid if a clear contact with only one foot on the appropriate force plate was detected. The subjects were asked to tell the examiners if they needed a rest or felt any discomfort or pain during the measurements. All participants accomplished the locomotion tasks free of pain.
Kinematic and kinetic raw data were filtered by means of a recursive Butterworth low-pass filter at a 6-Hz cutoff frequency. The Anybody™ Modeling System (AnyBody Technology, Aalborg, DK) was used to perform lower-limb inverse dynamics according to the anatomical landmark scaled model of Lund et al. . Standing reference trials were recorded for each subject to create a stick-figure model that was used to scale a cadaver dataset into subject-specific joint parameters. The defined knee joint coordinate system was based on Pennock and Clark . The computed angles from standing reference trials were subtracted from the appropriate dynamic captured trials. The modeled head and trunk were driven by the pelvis markers. In order to determine inertial properties more accurately, subjects’ whole-body anthropometrics were measured to adjust the inverse dynamic model. The mass of a segment was assumed to be the product of the volume of a frustum and the segment’s density . The knee joint was modeled as a spherical joint including three degrees of freedom, which were constrained using Anybody™’s Force-Dependent Kinematics method. A simple muscle model was used with third degree polynomial muscle recruitment. Kinematic and kinetic data were time-normalized to the stand phase, whereby the average of five valid trials was used for the analysis. KA patients’ operated limbs were compared with the right limbs of the CG. Further data processing was conducted with custom-built Matlab (2013b) routines (The MathWorks, Natick, USA). Knee biomechanics were assessed through the use of 3D angles and moments including peak varus angles, range of motion (RoM), peak adduction moments and knee adduction moment impulses within the first 50% of the stance phase. Peak angles, RoM and moments were extracted from the entire stance phase in the transverse plane. Joint moments are presented as external moments normalized to each subject’s mass and height. In order to detect increased lateral trunk sway indicating a potential compensatory mechanism, the distance between the ground projected CoM and the force application point (FAP) was calculated in the medial-lateral direction at the moment of the first peak knee adduction moment (FAP-CoMadd). The distance values were normalized to each subject’s height. Knee joint stiffness (Kstiff) was calculated in the transverse plane as the change in rotational knee joint moment (M), divided by the change in transverse plane knee joint angle (θ) between the initial ground contact and the instant of time when the knee joint was maximally internally rotated.
The step length and width were normalized to each subject’s height. Sagittal plane kinematics and kinetics were measured but are not presented nor discussed in the current article. The authors added for the interested reader sagittal plane results as supporting information in the form of the S1 and S2 Tables.
A test for normal distribution was performed using the Shapiro-Wilk Test. If the variables were normally distributed, univariate ANOVA was used to examine group differences. Individual between-group differences were clarified by means of a post hoc Tukey or Games-Howell test if the condition of homogeneity of variances was not fulfilled. In order to determine the interlimb asymmetry in the TKA and UKA group, the paired t-test was used. If variables were not normally distributed, the non-parametric Kruskal-Wallis Test was performed to detect between-group differences as well as the Wilcoxon-signed-rank test to determine interlimb asymmetries. The alpha level was set at 0.05 to detect a significant difference in all statistical tests. Effect size was calculated using eta-squared (η2) for ANOVA tests or Cohen’s d for interlimb comparisons. The point-biserial correlation (rpb) was used to determine the effect size for nonparametric tests . An effect size value of 0.5 represents a large effect, 0.3 a medium effect and 0.1 a small effect . Power analysis was conducted by means of the G*Power-software (G*Power Version 220.127.116.11, Kiel, Germany) in order to estimate the Type II error between the three investigated groups. All statistical tests were performed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., New York, USA).
Subjects’ characteristics and time-distance parameters
Both KA groups weighed significantly more than the CG accompanied by significantly greater BMI values. Further characteristics of all subjects are listed in Table 1 as mean values ± standard deviation. No significant group differences were detected concerning time-distance parameters (contact time, step length, step width, and walking velocity).
The TKA and UKA groups showed considerably lower peak internal rotation values for the operated knee compared with the CG during decline walking [6.8° (TKA, p = 0.012) and 4.4° (UKA)], whereby the difference was statistically significant only between the TKA group and the CG (Fig 1). The effect size of 0.28 indicates a moderate effect. Concerning the interlimb differences, the operated (OP) knees in the KA groups revealed significantly diminished peak internal rotation values than the non-OP knees which presented similar values to those in the CG (1.8 ± 6.6°). The peak knee internal rotation moments were nearly equal in all groups (Fig 2). In contrast, both KA groups revealed significant 25% (TKA, p = 0.041) and 12.5% (UKA, p = 0.015) increases in internal rotation moments in their non-OP knees in comparison with the OP knees.
Values are presented as mean curves (solid lines) ± standard deviations (SD, shaded areas). Positive values indicate internal rotation. Dotted lines represent the non-OP knee of the TKA group (red) and UKA group (blue). The green rectangle indicates significantly different peak values between the TKA-OP knee and the CG (p = 0.012), the TKA-OP knee and TKA non-OP knee (p = 0.002), the UKA-OP knee and UKA non-OP knee (p = 0.007).
Values are presented as mean curves ± standard deviations (SD, shaded areas). Positive values indicate internal rotation moments. Dotted lines represent the non-OP knee of the TKA group (red) and UKA group (blue). The green rectangles indicate significantly different peak values between the TKA-OP knee and TKA non-OP knee, the UKA-OP knee and UKA non-OP knee for the first 50% of the stance phase (TKA: p = 0.002, UKA: p = 0.003) as well as 50%–100% of the stance phase (TKA: p = 0.041, UKA: p = 0.015).
Furthermore, appreciable two-fold (TKA group) and six-fold (UKA group) higher joint stiffness values were observed in both KA groups for the OP knee compared with the non-OP knee during decline walking (Table 4). However, the difference was statistically significant only for the TKA group, whereas rpb values (TKA = 1.12, UKA = 0.54) indicate a meaningful difference between both KA groups and the CG. No significant difference was detected between the non-OP knee and the CG regarding joint stiffness.
The TKA group tended to accomplish level walking with decreased peak internal knee rotation in comparison with the UKA group and CG (CG: 3.0° ± 4.4; TKA: 0.49° ± 2.8; UKA: 4.5° ± 5.4; p = 0.103). Nevertheless, the interlimb comparison revealed a slight but significant decrease of 2.3° (p = 0.003, d = 0.76) peak internal rotation of the OP knee in the TKA group.
As shown in Table 3, similar results to those obtained with level walking were observed during the incline walking task, except for the RoM which was significantly greater in both KA groups compared with the CG.
No statistically significant differences were detected between the TKA and UKA group considering the investigated locomotion tasks and parameters. The static knee varus angles extracted from the KA subjects’ standing reference trials showed neither statistically significant intergroup (TKA: −3.6° ± 1.7; UKA: −1.7° ± 3.4, p = 0.90, d = 0.7) nor interlimb differences (TKA op: −3.6° ± 1.7; TKAnon op: −2.7° ± 4.4; p = 0.37, d = 0.27; UKA op: −1.66° ± 3.4; UKAnon op: −2.1° ± 3.0; p = 0.73; d = 0.14).
According to Table 4, both KA groups conducted their trials with greater peak knee varus angles in the non-OP knee compared with the OP knee, regardless of the locomotion task. However, the decline walking task revealed the most substantial discrepancies showing, e.g., greater RoM in the non-OP knee as well as 2.1° (TKA, p = 0.016, d = 1.07) and 1.9° (UKA, p = 0.008, d = 1.17) greater peak knee varus angles within the first 50% of the stance phase. No group differences were detected with regard to peak knee varus angles within the first 50% of the stance phase (Fig 3). Moreover, both KA groups negotiated decline walking with significant 27% (TKA, p = 0.001) and 22% (UKA, p = 0.007) reductions in first-peak knee adduction moments compared with the CG (Fig 4), accompanied by 14% lower adduction moment impulse values which did not reach statistical significance after post hoc analysis (p = 0.093CG-TKA, p = 0.072CG-UKA). The non-OP knee adduction moments and impulses of both KA groups were barely distinguished from the CG (Fig 4). No between-group or interlimb differences were observed concerning the FAP-CoMadd parameter, indicating that the subjects did not employ compensatory mechanisms, such as the Trendelenburg gait pattern.
Values are presented as mean curves ± standard deviations (SD, shaded areas). Positive values indicate varus alignment. Dotted lines represent the non-OP knee of the TKA group (red) and UKA group (blue). The green rectangle indicates significantly different peak values between the TKA-OP knee and TKA non-OP knee (p = 0.016), the UKA-OP knee and UKA non-OP knee (p = 0.008) for the first 50% of the stance phase.
Values are presented as mean curves (solid lines) ± standard deviations (SD, shaded areas). Positive values indicate adduction moments. Dotted lines represent the non-OP knee of the TKA group (red) and UKA group (blue). The green rectangle indicates significantly different peak values between the TKA-OP knee and CG (p = 0.001), the UKA-OP knee and CG (p = 0.007).
It is stated that UKA provides several advantages over TKA in terms of, for example, better function, faster rehabilitation and participation in more sporting activities, but first and foremost, UKA might provide kinematics similar to those of the native knee [34–36]. However, there are only a few studies investigating patients after UKA, TKA, and healthy CGs by means of optoelectronic systems based on stereophotogrammetry. The main focus of the research has been on level walking and sagittal plane mechanics, whereas frontal and particularly transverse plane evaluations are often neglected. Therefore, the current study aimed to address the mentioned aspects in order to expose potential differences that might be related to different implant designs and locomotion tasks. To the author’s knowledge, this is the first study to include ramp negotiation tasks with patients after KA surgery.
The authors’ first hypothesis was not supported by the results: the selected parameters did not show significant differences in the transverse plane between the UKA and TKA groups at any time, irrespective of the locomotion task. However, the second hypothesis was supported by the results. Both KA groups presented similar discrepancies in comparison with the CG regarding certain parameters, particularly during decline walking. Nevertheless, the TKA group showed more considerable abnormalities in the OP knee presenting reduced peak knee internal rotation angles during all tasks. Especially, decline walking exposed the most striking deficits in the TKA group compared with the CG. Interestingly, all groups showed nearly equal internal rotation moments, accompanied by greater, but not significantly different, transverse knee joint stiffness values in both KA groups. Particularly noteworthy are the internal knee rotation curve shapes for the non-OP knees of both KA groups, which are similar to the curve shape of the CG (Fig 1). These results illustrate, besides reduced peak values and diminished RoM, significantly greater joint stiffness values in the TKA group’s OP knee than in the non-OP knee. Indeed, the Wilcoxon signed-rank test exposed no statistical difference (p = 0.06) due to the high standard deviation between the OP knee and non-OP knee of the UKA group according to joint stiffness. Nevertheless, the values of 0.065 Nm/° (OP knee) versus 0.011 Nm/° (non-OP knee) and the corresponding effect size (0.54) suggest a meaningful result. The results concerning the constrained internal knee rotation are in agreement with the previous work of McClelland et al.  who reported decreased knee internal rotation angles in TKA patients compared with a healthy CG during level walking. In this regard, Wünschel et al.  also observed in a cadaveric study lower internal rotation values in TKA knees during kneeling activities. The authors conjectured that TKA may impair tibial internal rotation due to the concave shape of the inlay.
On the other hand, this aspect could not explain the reduced internal rotation in the UKA group, neither in the current study during decline walking nor in the study by Argenson et al. , because the UKA-tibial inlays were flat in both studies. The authors assumed that progressive laxity of the ACL may occur over time in UKA patients . Hence, neuromuscular factors could have a significant influence on the mentioned deficit, aside from different implant designs. It has been shown, that the hamstrings are able to rotate the tibia externally as well as inhibit anterior tibial translation in ACL-deficient knees by means of co-contraction [40,41]. Thus, due to the sloped ramp surface in the current study, increased tibial acceleration occurred in an anterior direction during decline walking compared with level walking (see supporting information, S2 Table). Consequently, greater co-contraction of the hamstrings was apparent during decline walking, particularly in the OP-knees of the TKA group, where the ACL was absent. Finally, the higher transverse joint stiffness values in the OP knee in contrast to the non-OP knee provide support for the above mentioned mechanism.
Although not calculated, the authors presume that increased coefficients of friction, which usually occur between a cobalt-chromium alloy and an ultra-high-molecular-weight polyethylene (UHMWPE) [42,43], might contribute to the impaired internal knee rotation of both KA groups in comparison with the non-OP knee and CG. Moreover, due to increased friction higher stress might occur on the interface between the tibial tray and bony structures. The extent of rotational load transmitted to the bone-implant interface is directly proportional to the frictional force. Due to rotational forces acting on the tibial tray, studies demonstrated torsional micromotion [28,44]. Transverse plane moments probably act like an unscrewing mechanism accompanied by axial and shear loads contributing to aseptic component loosening. In this regard, mobile-bearing TKA and UKA aim to improve survivorship rates providing more natural tibial internal rotation and reducing contact stresses compared with fixed-bearing implants by means of rotating platforms [45,46]. Nevertheless, mobile-bearing KA still remains controversial in terms of enhanced survivorship and more natural kinematics, essentially complicating the question to what extent the rotational behavior of the knee influences the lifespan of KA [47,48].
Similar to the results obtained in the transverse plane, the frontal plane results did not support the first hypothesis. No statistically significant differences between the TKA and UKA groups were observed concerning the selected parameters. In accordance with the second hypothesis, clear discrepancies were apparent, in particular during decline walking in both KA groups compared with the CG, where decreased first-peak knee adduction moments were present in the KA groups. The effect size of 0.36 clarifies a moderate clinical relevance in terms of reduced load in the medial compartment of the replaced knee, as the knee adduction moment is stated to be a surrogate indicator of load redistribution to the medial knee compartment [49,50]. Additionally, polyethylene wear primarily occurs in the medial compartment of the implants [51,52], although it should be considered that UHMWPE wear rates have been reduced in recent years due to improved mechanical properties of UHMWPE [26,27,53]. In the current study, knee adduction moments of both KA groups were significantly lower during decline walking but not different during the other investigated tasks compared with the CG. This suggests that a premature endoprosthesis failure due to wear of the medial implant compartment is unlikely. Studies have reported heterogeneous results concerning first-peak knee adduction kinetics in TKA patients, at least during level walking. In Benedetti et al.  TKA patients demonstrated significantly reduced knee adduction moments both 12 and 24 months post-surgery compared with a CG. The authors explained that measured compensatory mechanisms in the trunk could be responsible for the reduced knee adduction moments in the TKA group. Likewise, Urwin et al.  showed reduced knee adduction moments of TKA patients nine months post-surgery compared with controls. It is important to mention, that in both studies, the TKA patients performed level walking significantly more slowly than the appropriate CG, which could partly explain the mentioned differences. Contrarily, in the current study, no between-group differences were found with respect to gait velocity, regardless of the locomotion task. On the other hand, in a study by Worsley et al. , a mixed group consisting of TKA and UKA patients conducted level walking with slightly higher knee adduction moments compared with healthy controls (p = 0.27), whereby the non-OP knee showed higher values than the OP knee. In the current study, only the UKA group showed higher, but statistically not significantly different (p = 0.109), adduction moments in the OP knee during level walking. Interestingly, both KA groups accomplished decline walking with notably reduced knee adduction moments in their OP knee compared with the CG (η2 = 0.36). The non-OP knee exhibited greater knee adduction moments than the OP knee in either KA group (Fig 4) accompanied by greater varus angles in the non-OP knee (Fig 3). In this regard, it is important to mention that static reference trials exhibited normally aligned limbs and no interlimb asymmetries. However, knee adduction moments as well as adduction moment impulses of the non-OP knee did not exceed the CG’s values. Hence, reduced knee adduction moments in the affected knee do not necessarily result in a medial compartment overload of the contralateral non-replaced knee. In addition, compensatory mechanisms, such as increased lateral trunk sway in the frontal plane, which could explain the reduced knee adduction moments during decline walking in the OP knee, were not detected by means of the FAP-COPadd distance calculation.
Only a few studies included a CG or reported P-values. To the authors’ knowledge, there is no study investigating ramp negotiation with patients after TKA and UKA. Hence, it is difficult to integrate the results of the current study regarding sloped walking with the existing literature and therefore, comparisons should be treated with caution. However, the results of the current study clarify the importance of analyzing physically more demanding ADL, such as ramp negotiation, in addition to level walking. Although decline walking shows similar lower limb kinematics and kinetics to level walking [10,11], the knee joint seems to be mostly affected by negative inclinations, which is in accordance with previous literature. Thus, impairments after KA surgery should be more apparent during decline walking than level walking.
The present study has some limitations, especially with regard to the TKA group consisting of posterior stabilized and posterior cruciate ligament retained knee endoprosthesis. However, generally, no statistical differences in terms of functional and clinical parameters were detected in the previous literature. Nevertheless, the superiority of one of the prosthesis types remains controversial [57–59]. Data extracted from the transverse and frontal plane should be interpreted with caution due to its known sources of measurement and modeling issues [29,60]. In order to reduce bias due to high BMI values and associated increased soft-tissue artifacts, the authors excluded subjects with BMI values higher than 31. Furthermore, the authors placed particular importance on keeping the age of the subjects consistent (Table 1). The groups were not gender-matched, which may have affected the results of this study. Thus, on account of the strict inclusion criteria, it was not possible to include more subjects in the appropriate groups.
The results of the current study are in accordance with the second hypothesis explaining the significant importance of including walking on sloped surfaces in biomechanical studies and rehabilitative treatment evaluation of KA patients. Particularly, decline walking exposed appreciable discrepancies in both KA groups compared with the CG presenting compromised knee internal rotation, especially in the TKA group. However, the non-OP knee showed similar kinematics in the transverse plane compared with the CG’s. Contrary to the authors’ first hypothesis, no statistically significant differences between the TKA and UKA groups in terms of the parameters evaluated and locomotion tasks were found. Both KA groups exhibited similar discrepancies in the OP knee compared with the CG as well as to the KA groups’ non-OP knee, in particular during decline walking. However, the TKA group presented abnormal knee biomechanics to a greater extent than the UKA group. The relatively small sample size or insufficient measuring sensitivity could be potential reasons for the absence of statistically significant differences between the TKA and UKA group.
S1 Table. Sagittal plane knee kinematics and kinetics during level walking.
*Indicates significant difference between corresponding groups. Peak values are presented for the first 50% of stance phase. Mean (Ø) flexion velocity is calculated from heel strike until maximum knee flexion for the first 50% of stance phase.
S2 Table. Sagittal plane knee kinematics and kinetics during decline and incline walking.
*Indicates significant difference between corresponding groups. Peak values are presented for the first 50% of stance phase. Mean (Ø) flexion velocity is calculated from heel strike until maximum knee flexion for the first 50% of stance phase.
- Conceptualization: IK SW WP.
- Formal analysis: IK.
- Investigation: IK MP JF SD.
- Project administration: IK SW.
- Software: IK SD.
- Supervision: WP.
- Visualization: IK.
- Writing – original draft: IK.
- Writing – review & editing: WP JF.
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The first emperor of Rome, Augustus, exploited architecture to convey his sophisticated propaganda. He famously boasted to have found Rome a city of brick, and left it a city of marble. This claim has been considered an apt metaphor for the establishment of an imperial state, though the quantitative, physical veracity of the boast has never been fully interrogated. A team from UCLA mapped and modeled the marble projects added to Rome in the decades of Augustan power, using rule-based procedural modeling to generate numerous 3D, interactive, geo-temporal simulations of the entire cityscape with each marble intervention placed in situ topographically and chronologically. Broad, pan-urban views of the city’s evolution revealed that Augustan marble projects were neither overwhelming in number nor readily visible. Examination of the urban experience over time and space, however, revealed that marble construction had a constant and pervasive impact. Daily urban residents found their movements blocked by marble transports and their senses bombarded by the noisy, dusty work at construction sites. Thus, it was not the rhetoric conveyed by architecture that justified Augustus’ claim, but the rhetoric of the building act that spoke loudly and persuasively in situ.


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Generally, cord blood can only be used to treat children up to 65 lbs. This is because there simply aren’t enough stem cells on average in one unit of cord blood to treat an adult. Through our Cord Blood 2.0 technology, we have been able to collect up to twice as many stem cells as the industry average. Getting more stem cells increases the chance of being able to treat someone later in life.
Much research is focused on trying to increase the number of HSCs that can be obtained from one cord blood sample by growing and multiplying the cells in the laboratory. This is known as “ex vivo expansion”. Several preliminary clinical trials using this technique are underway. The results so far are mixed: some results suggest that ex vivo expansion reduces the time taken for new blood cells to appear in the body after transplantation; however, adult patients still appear to need blood from two umbilical cords. More research is needed to understand whether there is a real benefit for patients, and this approach has yet to be approved for routine clinical use.
The American Academy of Pediatrics supports efforts to provide information about the potential benefits and limitations of cord blood banking and transplantation so that parents can make an informed decision. In addition, the American College of Obstetricians and Gynecologists recommends that if a patient requests information on umbilical cord blood banking, balanced information should be given. Cord blood education is also supported by legislators at the federal and state levels. In 2005, the National Academy of Sciences published an Institute of Medicine (IoM) report titled “Establishing a National Cord Blood Stem Cell Bank Program”.
In Europe and other parts of the world, cord blood banking is more often referred to as stem cell banking. As banking cord blood is designed more to collect the blood-forming stem cells and not the actual blood cells themselves, this term may be more appropriate.
In the United States, the Food and Drug Administration regulates any facility that stores cord blood; cord blood intended for use in the person from whom it came is not regulated, but cord blood for use in others is regulated as a drug and as a biologic. Several states also have regulations for cord blood banks.
Yes, stem cells can be used on the donor following chemo and radiation to repair the bone marrow. For a full list of treatments, please visit : http://cellsforlife.com/cord-blood-basics/diseases-treated-with-cord-blood-stem-cells/
Advances in treatment methods, including the use of PBSCT, have reduced the amount of time many patients must spend in the hospital by speeding recovery. This shorter recovery time has brought about a reduction in cost. However, because BMT and PBSCT are complicated technical procedures, they are very expensive. Many health insurance companies cover some of the costs of transplantation for certain types of cancer. Insurers may also cover a portion of the costs if special care is required when the patient returns home.
The Medical Letter On Drugs and Therapeutics also recently addressed aspects of public and private cord blood banks, asking the question: “Does Private Banking Make Sense?” After citing various statistics on the actual uses of privately stored cord blood, they concluded that: “At the present time, private storage of umbilical cord blood is unlikely to be worthwhile. Parents should be encouraged to contribute, when they can, to public cord blood banks instead.” [Access The Medical Letter at www.medicalletter.org].
^ Li, T; Xia, M; Gao, Y; Chen, Y; Xu, Y (2015). “Human umbilical cord mesenchymal stem cells: an overview of their potential in cell-based therapy”. Expert Opinion on Biological Therapy. 15 (9): 1293–306. doi:10.1517/14712598.2015.1051528. PMID 26067213.
Generally not. The reason siblings are more likely to match is because they get half of their HLA markers from each parent. Based on the way parents pass on genes, there is a 25 percent chance that two siblings will be a whole match, a 50 percent chance they will be a half match, and a 25 percent chance that they will not be a match at all. It is very rare for a parent to be a match with their own child, and even more rare for a grandparent to be a match.
Though uses of cord blood beyond blood and immunological disorders is speculative, some research has been done in other areas. Any such potential beyond blood and immunological uses is limited by the fact that cord cells are hematopoietic stem cells (which can differentiate only into blood cells), and not pluripotent stem cells (such as embryonic stem cells, which can differentiate into any type of tissue). Cord blood has been studied as a treatment for diabetes. However, apart from blood disorders, the use of cord blood for other diseases is not in routine clinical use and remains a major challenge for the stem cell community.
^ Reddi, AS; Kuppasani, K; Ende, N (December 2010). “Human umbilical cord blood as an emerging stem cell therapy for diabetes mellitus”. Current stem cell research & therapy. 5 (4): 356–61. doi:10.2174/157488810793351668. PMID 20528762.
Luckily for expectant parents, cord blood can be easily collected at the baby’s birth via the umbilical cord with no harm to the mother or baby. This is why pregnancy is a great time to plan to collect and bank a baby’s cord blood.
As the research into umbilical cord blood and it’s therapeutic use for blood diseases has grown, so has the question as to whether people should privately store the cord blood of their offspring for future use. A recent paper on this issue by Mahendra Rao and colleagues advocates the practice of cord blood banking (for treatment of blood diseases) but in the context of public cord blood banks rather than a private cord blood banks. Any adult needing treated would need at least two cord blood samples that are immune compatible. So one sample will not be sufficient. A child might only need one cord blood sample but in the case of childhood leukaemia there is a risk that pre-leukemic cells are present in cord blood sample – and so the child could not use their own cells for therapy.
In this way, cord blood offers a useful alternative to bone marrow transplants for some patients. It is easier to collect than bone marrow and can be stored frozen until it is needed. It also seems to be less likely than bone marrow to cause immune rejection or complications such as Graft versus Host Disease. This means that cord blood does not need to be as perfectly matched to the patient as bone marrow (though some matching is still necessary).
Cord blood is also being studied as a substitute for normal blood transfusions in the developing world. More research is necessary prior to the generalized utilization of cord blood transfusion.
Meet Dylan. Diagnosed with leukemia at just 8 weeks old, he received a life-saving cord blood transplant at 6 months old. Today, Dylan is growing up strong, going to school, travelling with his family and just having fun being a kid!
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As noted, there are different ways to process cord blood, and although the type of processing method doesn’t always enter the conversation on cord blood banking, it is a big part of the purity of any cord blood collection. Red blood cells can have a negative impact on a cord blood transfusion. In addition, there is a certain number of stem cells that need to be present in order for the cord blood to be effective in disease treatment. Each processing method has the ability to better reduce the number of RBCs and capture more stem cells. Some processing methods like AutoXpress and Sepax are automated to ensure a level of consistency across all collections. HES is preferred by some banks because it was the original processing method used by most banks and it has a proven track record. You can read more about the different cord blood processing methods here.
Unlike other banks, CBR uses a seamless cryobag for storage. The seamless construction decreases the potential for breakage that can occur in traditional, seamed-plastic storage bags. Prior to storage, each cryobag is placed in a second overwrap layer of plastic, which is hermetically sealed as an extra precaution against possible cross contamination by current and yet unidentified pathogens that may be discovered in the future. CBR stores the stem cells in vaults, called dewars, specially designed for long-term cryostorage. The cord blood units are suspended above a pool of liquid nitrogen that creates a vapor-phase environment kept at minus 196 degrees Celsius. This keeps the units as cold as liquid nitrogen without immersing them in liquid, which can enable cross-contamination. Cryopreserved cord blood stem cells have proven viable after more than 20 years of storage, and research suggests they should remain viable indefinitely.
Each cord blood bank has different directions for returning the consent form. Some banks may ask you to mail the consent form along with the health history forms or to bring the original consent form with you to the hospital. Other banks may have you finish the form at the hospital. Follow the directions from your public cord blood bank.
There are options for relieving the financial burden associated with BMT and PBSCT. A hospital social worker is a valuable resource in planning for these financial needs. Federal government programs and local service organizations may also be able to help.
Bone marrow transplantation, also called hemopoietic stem cell transplantation, is under investigation for the treatment of severe forms of multiple sclerosis. The long-term benefits of this experimental procedure have not yet been established. In this procedure, the individual receives grafts of his or her own blood stem cells, and thus donor stem cells are not used or needed.
After entering the bloodstream, the stem cells travel to the bone marrow, where they begin to produce new white blood cells, red blood cells, and platelets in a process known as “engraftment.” Engraftment usually occurs within about 2 to 4 weeks after transplantation. Doctors monitor it by checking blood counts on a frequent basis. Complete recovery of immune function takes much longer, however—up to several months for autologous transplant recipients and 1 to 2 years for patients receiving allogeneic or syngeneic transplants. Doctors evaluate the results of various blood tests to confirm that new blood cells are being produced and that the cancer has not returned. Bone marrow aspiration (the removal of a small sample of bone marrow through a needle for examination under a microscope) can also help doctors determine how well the new marrow is working.
If you want the blood stored, after the birth, the doctor clamps the umbilical cord in two places, about 10 inches apart, and cuts the cord, separating mother from baby. Then she inserts a needle and collects at least 40 milliliters of blood from the cord. The blood is sealed in a bag and sent to a lab or cord blood bank for testing and storage. The process only takes a few minutes and is painless for mother and baby.
If you’re looking to attain cord blood from a public bank, be aware that matched cord blood, as with bone marrow, can be difficult to obtain through a public cord blood bank. Once a match is ascertained, it may take valuable weeks, even months, to retrieve the match, and the cost of acquiring the cord blood from a public bank can be upwards of $40,000. When the newborn’s umbilical cord blood is banked privately, they can be retrieved quickly, and since the parents own the cord blood, banks can perform the retrieval free of charge. Learn more about public versus private cord blood banking here.
Upon arrival at CBR’s laboratory, the kit is immediately checked in and inspected. Next, the cord blood unit is tested for sterility, viability, and cell count. In addition, the cord tissue is tested for sterility. CBR processes cord blood using the AutoXpress® Platform* (AXP®) – a fully automated, functionally closed stem cell processing technology. The AXP platform is an integral component of CBR’s proprietary CellAdvantage® system. CBR has the industry’s highest published average cell recovery rate of 99%.
Students who register to donate blood three or more times during their high school career earn a Red Cord to wear during graduation events. Seniors must complete the requirement by May 15 (or by the date of their school’s final blood drive of the year, whichever is later).
Part of the reason for the dominance of these three companies in terms of the total number of units stored is that they are three of the oldest cord blood banks within the U.S., founded in 1992, 1993, and 1989, respectively. All three of these cord blood banks also support cord blood research and clinical trials.
Banking cord blood is a new type of medical protection, and there are a lot of questions that parents may want to ask. The Parent’s Guide to Cord Blood organization even has questions it believes all parents should ask their cord blood banks. We have answers to these and other frequently asked cord blood questions in our FAQs. If you can’t find the answer for which you are looking, please feel free to engage one of our cord blood educators through the website’s chat interface.
Some parents-to-be are sold on the advertising that banking their child’s cord blood could potentially treat an array of diseases the child, or his siblings, could encounter in their lives. Other parents-to-be may find all the promises too good to be true.
Cord Blood Registry is headquartered in South San Francisco, California. CBR owns their 80,000 square foot laboratory located in Tucson, Arizona. CBR’s laboratory processes cord blood collections seven days a week, 365 days a year. The state-of-the-art facility has the capacity to store the stem cell samples of five million newborns.
The American Pediatric Association in 2008 recommended that physicians recommend that cord blood be donated instead of saved privately for family families. One of the major proponents for this was Joanne Kurtzberg, who profited from this by getting funding for her public cord blood bank at Duke University. She has since started her own private cord blood bank after doing more research on Cerebral Palsy. Interesting.
The National Marrow Donor Program® (NMDP), a nonprofit organization, manages the world’s largest registry of more than 11 million potential donors and cord blood units. The NMDP operates Be The Match®, which helps connect patients with matching donors.
In Europe, Canada, and Australia use of cord blood is regulated as well. In the United Kingdom the NHS Cord Blood Bank was set up in 1996 to collect, process, store and supply cord blood; it is a public cord blood bank and part of the NHS.
CBR Clients: Did you know that when you refer a friend, and they preserve their baby’s stem cells with us, you receive a free year of cord blood storage? After your first referral, you start earning even more rewards. (exclusions apply). Refer a friend now: http://bit.ly/2JAGrcu
Adverse effects are similar to hematopoietic stem cell transplantation, namely graft-versus-host disease if the cord blood is from a genetically different person, and the risk of severe infection while the immune system is reconstituted. There is a lower incidence with cord blood compared with traditional HSCT, despite less stringent HLA match requirements.
Sign a consent form to donate. This consent form says that the donated cord blood may be used by any patient needing a transplant. If the cord blood cannot be used for transplantation, it may be used in research studies or thrown away. These studies help future patients have a more successful transplant.
Lead image of baby’s umbilical cord from Wikimedia Commons. Possible human blood stem cell image by Rajeev Gupta and George Chennell. Remaining images of blood sample bags and red blood cells from Wellcome Images.
As most parents would like to bank their babies’ cord blood to help safeguard their families, it is often the cost of cord blood banking that is the one reason why they do not. Most cord blood banks have an upfront fee for collecting, processing and cryo-preserving the cord blood that runs between $1,000 and $2,000. This upfront fee often also includes the price of the kit provided to collect and safely transport the cord blood, the medical courier service used to expedite the kit’s safe shipment, the testing of the mother’s blood for any infectious diseases, the testing of the baby’s blood for any contamination, and the cost of the first full year of storage. There is then often a yearly fee on the baby’s birthday for continued storage that runs around $100 to $200 a year.
Cord blood (short for umbilical cord blood) is the blood that remains in the umbilical cord and placenta post-delivery. At or near term, there is a maternal–fetal transfer of cells to boost the immune systems of both the mother and baby in preparation for labor. This makes cord blood at the time of delivery a rich source of stem cells and other cells of the immune system. Cord blood banking is the process of collecting the cord blood and extracting and cryogenically freezing its stem cells and other cells of the immune system for potential future medical use.
Cord blood is collected by your obstetrician or the staff at the hospital where you give birth. Not all hospitals offer this service. Some charge a separate fee that may or may not be covered by insurance.
Your baby’s newborn stem cells are transported to our banking facilities by our medical courier partner, and you can receive tracking updates. Each sample is processed and stored with great care at our laboratory in Tucson, Arizona. CBR’s Quality Standard means we test every cord blood sample for specific quality metrics.

domain: medical


text:
BlizzCon 2017 had a lot of major announcements across many of Blizzard’s biggest franchises. Overwatch got a new character and map. World of Warcraft got a new expansion and legacy server. Heroes of the Storm had new characters being brought in. But arguably the most intriguing announcement was that StarCraft II: Wings of Liberty was going to go free-to-play. This was a very bold move by Blizzard, and some wonder if this is an indication that they’re up for doing similar things with their other games too.
To be clear, the “free-to-play” aspect applies to the full multiplayer of the game, and then the first third of the singleplayer campaign. And even within the multiplayer there are restrictions you must do in order to go into ranked matches. That being said, there’s still a lot of content to do for a free-to-play StarCraft II game.
So, is this a sign of things to come for Blizzard?
Well, it certainly would be interesting, wouldn’t it? The game could be the first to start a trend for Blizzard to bring some of its other games to the free-to-play fold. Imagine being able to play Overwatch for a certain amount of time before hitting the pay wall, that could bring even more people to the game (35 million and counting!).
The big one that is gaining momentum though is Diablo III. With it being over 5 years old, many are wondering if Blizzard should make a chunk of its playing time free-to-play. The fanbase would certainly love that, and it could build interest should their be Diablo IV.
Either way though, what StarCraft II is doing is very good for business, and if Blizzard does well off of it, you might see it in other games of theirs as well.

domain: game


Kyle Kinkade, you may remember, is one of the
original early developers of Tap Tap Revenge (one of the biggest hits of the App Store's first generation of games). He was last seen working on Bartleby's Book of Buttons, a beautiful and interactive book for the iPad. This week at the MacTech IT and developers' conference here in Los Angeles, Kinkade took the stage to talk about AirPlay, a technology that he says has some major ramifications and consequences for both Apple and the entire interactive entertainment industry going forward. "By 2014," Kinkade said of AirPlay integration, and multiscreen interaction, "this will be a very common thing."
Kinkade began by showing off some examples of AirPlay integration, and how developers had learned to use the service so far. The core function of AirPlay is simply to send a video signal from your Apple device up to a larger screen, either out to a television or to your computer. Apps like Netflix and the TED talks app, for example, are simply kicking out video to the larger screen. But Kinkade also pointed out that AirPlay is being used more and more in other ways as well: Some games are using AirPlay to send a larger signal to then be controlled by the handheld device, and other apps (including Kinkade's own Bartleby book) are actually creating two different experiences, whether you're playing on just the smaller screen, or with the large screen also showing other context and information.
In fact, said Kinkade, lots of AirPlay functionality is actually not just being shown on a bigger TV or a computer screen, but on a full 5.1 home theater system. Developers, he said, shouldn't just think of AirPlay as a fun gimmick to see iPhone graphics on the big screen, but they should start thinking about it as a larger experience, as an entire second app or maybe even as the primary function of all kinds of apps, from games to productivity apps to anything else. Devs should not only think about sound as they design, and "do more than mirror" information on both screens, but they should "consider multiple dual screen paradigms" as they code, realizing that users are going to be appreciating and even expecting functionality like this going forward.
For his own app, Kinkade says he's not yet seeing anywhere near a majority of users investing in AirPlay, but the numbers are growing, from about 5% of users a year ago, to more than 11% at the current time. Kinkade also said that as other "second screen" technologies get more and more popular (like Microsoft's Project Glass functionality, and Nintendo's Wii U game console), AirPlay will have a chance to really lead the industry. "When it's no longer nerdy to have a screen in your hands as you play a game," said Kinkade, then AirPlay will become hugely important.
And finally, Kinkade suggested that Apple was thinking along these lines already. "Apple's taking AirPlay pretty seriously," said Kinkade. "You just don't know it yet." The company has been adding more and more functionality to AirPlay already (including the mirroring function), and Kinkade says that when Apple does reveal its final plans for AirPlay, developers already familiar with how it works and how it can be used will have a distinct advantage. His talk was definitely convincing: AirPlay is already a very fascinating technology, and it's easy to see how Apple, developers, and eventually users will have lots of fun and useful ways to take advantage of it in the future.


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This elegant formula can provide support for seasonal sufferers through an innovative blend of flavonoids, Vitamin C and Diindolylmethane (DIM).
Two of the most effective flavonoids are quercetin and luteolin.
Vitamin C can support normal immune system function and diamine oxidase (DAO).
A key centerpiece of this innovative formula is its novel focus on Nrf2, our body’s master antioxidant switch, which regulates over 200 genes involved in detoxification. Both DIM and quercetin have been shown to help support Nrf2 activity.
Quicksilver Delivery Systems® utilizes modern science to unleash the power of nature. With the world’s most advanced phospholipid delivery systems, Quicksilver Scientific supplements can help to nourish your cells with phosphatidylcholine as they deliver their core effective ingredients faster and more efficiently.
|Serving Size: 2 ml|
|Quali™-C Vitamin C (from European Sodium Ascorbate)||170 mg|
|Quercetin dihydrate||16 mg|
|Luteolin extract||20 mg|
|Proprietary Blend||120 mg|
Other Ingredients: Glycerin, Water, Ethanol, Vitamin E (as Tocofersolan and Natural Mixed Tocopherols), Medium-Chain Triglycerides, Natural Citrus Oils
Disclaimer: These statements have not been evaluated by the Food and Drug Administration (FDA). These products are not meant to diagnose treat or cure any disease or medical condition. Please consult your doctor before starting any exercise or nutritional supplement program or before using these or any product during pregnancy or if you have a serious medical condition.
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domain: health